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Meshkani Z, Moradi N, Aboutorabi A, Jafari A, Shams R. Subjective valuation of Iranian women for screening for gene-related diseases: a case of breast cancer. BMC Public Health 2023; 23:667. [PMID: 37041634 PMCID: PMC10088156 DOI: 10.1186/s12889-023-15568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND About 5-10% of breast cancer cases are attributed to a gene mutation. To perform preventive interventions for women with a gene mutation, genetic screening BRCA tests have recently been implemented in Iran. The present study aimed to determine Iranian women's subjective valuation for screening BRCA tests for early detection of breast cancer to help policymakers to make decisions about genetic screening tests for breast cancer and to know the applicants. METHODS An online survey was completed by women older than 30 years old in Tehran, the capital of Iran in 2021. A hypothetical scenario about genetic screening tests for breast cancer was defined. The subjective valuation for the tests was assessed by a willingness to pay (WTP) using the contingent valuation method (CVM) by payment card. Demographics, history of breast cancers, knowledge, and physiological variables were considered as independent variables, and a logistic regression model assessed the relationship between WTP and the variables. RESULTS 660 women were included. 88% of participants intended to participate in BRCA genetic screening for breast cancer if it were free. The mean WTP for the tests was about $ 20. Based on the logistic regression, income, family history of breast or ovarian cancer, and positive attitude were associated with WTP. CONCLUSIONS Iranian women were willing to intend for genetic screening BRCA tests and pay for them as well. The result of the present study is of great importance for policy makers when it comes to funding and determining co-payments for BRCA genetic screening tests. To achieve a high participation rate of women in breast cancer screening plans, a positive attitude should be promoted as a psychological factor. Educational and informative programs can help.
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Affiliation(s)
- Zahra Meshkani
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Ali Aboutorabi
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of health Management and Information Sciences, Shiraz University of Medical sciences, Shiraz, Iran
| | - Roshanak Shams
- Bone and Joint Reconstruction Research center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Wang H, Chen LS, Hsiao HY, Hsiao SC, Han T, Chang E, Assoumou B, Wang JHY. Chinese American and Non-Hispanic White Breast Cancer Patients' Knowledge and Use of BRCA Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3384. [PMID: 36834079 PMCID: PMC9959522 DOI: 10.3390/ijerph20043384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer among Chinese American women. Knowing the BRCA1 and BRCA2 (BRCA1/2) gene mutation status can improve breast cancer patients' health outcomes by guiding targeted treatment towards preventing breast cancer recurrence and other BRCA-related cancers. Nevertheless, it is unclear if there is a disparity in knowledge and use of BRCA testing among Chinese American breast cancer patients. This cross-sectional study investigated the possible presence of differences in the knowledge and the use of BRCA testing between Chinese American and Non-Hispanic White (NHW) breast cancer patients. We surveyed 45 Chinese American and 48 NHW adult breast cancer patients who had been diagnosed with breast cancer within the previous two years through telephone interviews. The results showed that race was not statistically related to the use of BRCA testing. BRCA testing utilization was associated with family history (p < 0.05) and age (p < 0.05). However, Chinese American participants' understanding of BRCA testing was significantly lower than that of NHW participants (p = 0.030). Our findings suggest that a disparity exists in BRCA testing knowledge between Chinese American and NHW breast cancer patients. Genetic education and counseling are needed to improve BRCA testing knowledge and uptake among Chinese American breast cancer patients.
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Affiliation(s)
- Haocen Wang
- School of Nursing, Purdue University, West Lafayette, IN 47907, USA
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
| | - Lei-Shih Chen
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
| | - Hsin-Yi Hsiao
- Department of Social Work, Tzu Chi University, Hualien 97074, Taiwan
| | - Suh Chen Hsiao
- Department of Adult Mental Health and Wellness, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Tian Han
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Emily Chang
- Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Bertille Assoumou
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
- Department of Surgery, University of Nevada, Las Vegas, NV 89154, USA
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
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Guo F, Hirth JM, Fuchs EL, Cofie LE, Brown V, Kuo YF, Fernandez ME, Berenson AB. Knowledge, Attitudes, Willingness to Pay, and Patient Preferences About Genetic Testing and Subsequent Risk Management for Cancer Prevention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:362-369. [PMID: 32642924 PMCID: PMC7794087 DOI: 10.1007/s13187-020-01823-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Knowledge, attitudes, and patient preferences about genetic testing and subsequent risk management for cancer prevention among average risk populations are understudied, especially among Hispanics. This study was to assess these items by conducting an in-person survey in this understudied population. We conducted in-person surveys using a self-administered, structured questionnaire among young women in 2017. Survey questions were adapted from other validated surveys. This study had 677 participants in the final analyses. Data were collected in 2017 and analyzed in 2018 and 2019. Participants had little knowledge about genes or breast cancer risk, but most felt that genetic testing for cancer prevention is "a good idea" (87.0%), "a reassuring idea" (84.0%), and that "everyone should get the test" (87.7%). Most (64.0%) of these women would pay up to $25 for the test, 29.3% would pay $25-$500, and < 10% would pay more than $500 for the test. When asked about a hypothetical scenario of high breast cancer risk, 34.2% Hispanics and 24.5% non-Hispanics would choose chemoprevention. Women would be less likely to choose risk reduction procedures, such as mastectomy (19.6% among Hispanics and 15.1% among non-Hispanics) and salpingo-oophorectomy (11.8% among Hispanics and 10.7% among non-Hispanics). In this low-income, mostly Hispanic population, knowledge about genetic testing and cancer risk is poor, but most have positive opinions about genetic testing for cancer prevention. However, their strong preference for chemoprevention and lesser preference for prophylactic surgeries in a hypothetical scenario underscore the importance of genetic counseling and education.
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Affiliation(s)
- Fangjian Guo
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA.
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA.
| | - Jacqueline M Hirth
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Erika L Fuchs
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Leslie E Cofie
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Veronica Brown
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Yong-Fang Kuo
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Office of Biostatistics, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX, USA
- Institute for Translational Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
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Smith-Uffen M, Bartley N, Davies G, Best M. Motivations and barriers to pursue cancer genomic testing: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1325-1334. [PMID: 33390305 DOI: 10.1016/j.pec.2020.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Single-gene testing is associated with psycho-social challenges for cancer patients. Genomic testing may amplify these. The aim of this study was to understand patients' motivations and barriers to pursue cancer genomic testing, to enable healthcare providers to support their patients throughout the testing process and interpretation of test results. METHODS Five databases were searched for original peer reviewed research articles published between January 2001 and September 2018 addressing motivation for genomic cancer testing. QualSyst was used to assess quality. RESULTS 182 studies were identified and 17 were included for review. Studies were heterogenous. Both somatic and germline testing were included, and 14 studies used hypothetical scenarios. 3249 participants were analyzed, aged 18 to 94. Most were female and white. The most common diagnoses were breast, ovarian, lung and colorectal cancer. Interest in testing was high. Motivations included ability to predict cancer risk, inform disease management, benefit families, and understand cancer. Barriers included concerns about cost, privacy/confidentiality, clinical utility, and psychological harm. CONCLUSIONS Despite concerns, consumers are interested in cancer genomic testing if it can provide actionable results for themselves and their families. PRACTICE IMPLICATIONS Providers must manage understanding and expectations of testing and translate genetic information into health-promoting behaviours.
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Affiliation(s)
- Megan Smith-Uffen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Nicci Bartley
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Grace Davies
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Megan Best
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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Alimena S, Scarpetti L, Blouch EL, Rodgers L, Shannon K, Del Carmen M, Goodman A, Growdon WB, Eisenhauer E, Sisodia RC. Factors associated with referral and completion of genetic counseling in women with epithelial ovarian cancer. Int J Gynecol Cancer 2020; 30:1397-1403. [PMID: 32447294 DOI: 10.1136/ijgc-2019-001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The National Comprehensive Cancer Network recommends that all women diagnosed with epithelial ovarian cancer undergo genetic testing, as the diagnosis of pathogenic variants may inform cancer survival and impact treatment options. The objective of this study was to assess factors associated with referral to genetic counseling in women with epithelial ovarian cancer. METHODS A retrospective cohort study identified women with epithelial ovarian cancer from 2012 to 2017 at Massachusetts General Hospital and North Shore Medical Center, a community hospital affiliated with Massachusetts General Hospital. Multivariate logistic regression evaluated how race, age, stage, year of diagnosis, insurance status, family history of breast or ovarian cancer, and language relates to the receipt of genetic counseling. RESULTS Of the total 276 women included, 73.9% were referred for genetic screening, of which 90.7% attended a genetic counseling visit. Older women were less likely to undergo genetic counseling (age ≥70 years: OR 0.26, 95% CI 0.07-0.94, p=0.04). Women who died within 365 days of initial oncology consult rarely reached a genetic counselor (OR 0.05, 95% CI 0.01-0.24, p<0.001). Women with a family history of breast or ovarian cancer were more likely to undergo counseling (OR 3.27, 95% CI 1.74-6.15, p<0.001). There was no difference in receipt of genetic counseling by race, stage, year of diagnosis, insurance status, or language. CONCLUSION Older women with epithelial ovarian cancer and those who died within 1 year of initiation of care were less likely to undergo recommended genetic counseling. Race, insurance status, and language were not identified as predictive factors, although we were limited in this assessment by small sample size.
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Affiliation(s)
- Stephanie Alimena
- Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Scarpetti
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erica L Blouch
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Linda Rodgers
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristen Shannon
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Eisenhauer
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Clark Sisodia
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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6
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Lee SH, Lee H, Lim MC, Kim S. Knowledge and Anxiety Related to Hereditary Ovarian Cancer in Serous Ovarian Cancer Patients. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2019; 25:365-378. [PMID: 37679908 DOI: 10.4069/kjwhn.2019.25.4.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 09/09/2023] Open
Abstract
PURPOSE The awareness of hereditary breast and ovarian cancer (HBOC) and BRCA testing is increasing in Korea. Compared to the sizable research on HBOC knowledge among breast cancer women, studies in the ovarian cancer population are limited. This paper aimed to investigate the level of knowledge of hereditary ovarian cancer and anxiety in women diagnosed with serous ovarian cancer in Korea and determine differences in the knowledge and anxiety according to whether genetic testing was undertaken and whether BRCA1 or BRCA2 mutations were present. METHODS Using a descriptive research design, a cross-sectional survey was conducted on 100 women diagnosed with serous ovarian cancer at N hospital in Gyeonggi-do, Korea, from July to November 2018. The collected data were analyzed by descriptive statistics, independent t-tests, one-way analysis of variance, and Pearson's correlation coefficient using the SPSS 21.0 program. RESULTS The hereditary ovarian cancer-related knowledge score was mid-level (mean score 8.90±3.29 out of a total of 17), as was the state anxiety level was mid-level (mean score 47.96±3.26 out of possible score range of 20-80). Genetic knowledge of hereditary ovarian cancer was associated with age, education, occupation, genetic counseling, and BRCA mutations. There were no statistically significant factors related to anxiety and there were no statistically significant correlations between knowledge level and anxiety. CONCLUSION More comprehensive education on gene-related cancer is needed for ovarian cancer patients, especially for items with low knowledge scores. A genetic counseling protocol should be developed to allow more patients to alleviate their anxiety through genetic counseling.
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Affiliation(s)
- Sang Hee Lee
- Student, College of Nursing, Yonsei University, Seoul, Korea
| | - Hyangkyu Lee
- Student, College of Nursing, Yonsei University, Seoul, Korea
| | - Myong Cheol Lim
- Student, College of Nursing, Yonsei University, Seoul, Korea
| | - Sue Kim
- Student, College of Nursing, Yonsei University, Seoul, Korea
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Vos S, van Diest PJ, Ausems MGEM, van Dijk MR, de Leng WWJ, Bredenoord AL. Ethical considerations for modern molecular pathology. J Pathol 2018; 246:405-414. [DOI: 10.1002/path.5157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/03/2018] [Accepted: 08/14/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Shoko Vos
- Department of Pathology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Paul J van Diest
- Department of Pathology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Margreet GEM Ausems
- Department of Medical Genetics; University Medical Center Utrecht; Utrecht The Netherlands
| | - Marijke R van Dijk
- Department of Pathology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Wendy WJ de Leng
- Department of Pathology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities; University Medical Center Utrecht; Utrecht The Netherlands
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8
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Blouin-Bougie J, Amara N, Bouchard K, Simard J, Dorval M. Disentangling the determinants of interest and willingness-to-pay for breast cancer susceptibility testing in the general population: a cross-sectional Web-based survey among women of Québec (Canada). BMJ Open 2018; 8:e016662. [PMID: 29487071 PMCID: PMC5855474 DOI: 10.1136/bmjopen-2017-016662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify common and specific individual factors that favour or impede women's interest in and willingness-to-pay (WTP) for breast cancer susceptibility testing (BCST) and to identify the most impactful factors on both outcome measures. DESIGN AND METHODS This study used a self-administered cross-sectional Web-based questionnaire that included hypothetical scenarios about the availability of a new genetic test for breast cancer. PARTICIPANTS French-speaking women of the general population of Québec (Canada), aged between 35 and 69 years, were identified from a Web-based panel (2410 met the selection criteria, 1160 were reached and 1031 completed the survey). MEASURES The outcomes are the level of interest in and the range of WTP for BCST. Three categories of individual factors identified in the literature were used as potential explanatory factors, that is, demographic, clinical and psychosocial. RESULTS Descriptive statistics indicated that the vast majority of sampled women are interested in BCST (90%). Among those, more than half of them are willing-to-pay for such a test (57%). The regression models pointed out several factors associated with both outcomes (eg, age, income, family history, locus of control-powerful others) and marginal effects were used to highlight the most impactful factors for each outcome. CONCLUSION The results of this study provide a proxy of the readiness of women of the general population to use and to pay for BCST. They also offer insights for developing inclusive and specific strategies to foster informed decision-making and guide the services offered by health organisations corresponding to women's preferences and needs.
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Affiliation(s)
| | - Nabil Amara
- Department of Management, Université Laval, Québec, QC, Canada
| | - Karine Bouchard
- Centre des maladies du sein Deschênes-Fabia, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Jacques Simard
- Faculty of Medicine, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada
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Ngene SO, Adedokun B, Adejumo P, Olopade O. Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women. J Genet Couns 2017; 27:863-873. [PMID: 29260484 DOI: 10.1007/s10897-017-0194-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Abstract
Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents' mean age was 34.9 years (SD = 10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR = 2.35, 95% CI, 1.07-5.13), religion (OR = 3.51, 95% CI, 1.03-11.92), and perceived personal risk if a close relative had breast cancer (OR = 2.31, 95% CI, 1.05-5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.
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Affiliation(s)
- Samuel O Ngene
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Babatunde Adedokun
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
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Hann KEJ, Freeman M, Fraser L, Waller J, Sanderson SC, Rahman B, Side L, Gessler S, Lanceley A. Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: a systematic review. BMC Public Health 2017; 17:503. [PMID: 28545429 PMCID: PMC5445407 DOI: 10.1186/s12889-017-4375-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/07/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Genetic testing for risk of hereditary cancer can help patients to make important decisions about prevention or early detection. US and UK studies show that people from ethnic minority groups are less likely to receive genetic testing. It is important to understand various groups' awareness of genetic testing and its acceptability to avoid further disparities in health care. This review aims to identify and detail awareness, knowledge, perceptions, and attitudes towards genetic counselling/testing for cancer risk prediction in ethnic minority groups. METHODS A search was carried out in PsycInfo, CINAHL, Embase and MEDLINE. Search terms referred to ethnicity, genetic testing/counselling, cancer, awareness, knowledge, attitudes, and perceptions. Quantitative and qualitative studies, written in English, and published between 2000 and 2015, were included. RESULTS Forty-one studies were selected for review: 39 from the US, and two from Australia. Results revealed low awareness and knowledge of genetic counselling/testing for cancer susceptibility amongst ethnic minority groups including African Americans, Asian Americans, and Hispanics. Attitudes towards genetic testing were generally positive; perceived benefits included positive implications for personal health and being able to inform family. However, negative attitudes were also evident, particularly the anticipated emotional impact of test results, and concerns about confidentiality, stigma, and discrimination. Chinese Australian groups were less studied, but of interest was a finding from qualitative research indicating that different views of who close family members are could impact on reported family history of cancer, which could in turn impact a risk assessment. CONCLUSION Interventions are needed to increase awareness and knowledge of genetic testing for cancer risk and to reduce the perceived stigma and taboo surrounding the topic of cancer in ethnic minority groups. More detailed research is needed in countries other than the US and across a broader spectrum of ethnic minority groups to develop effective culturally sensitive approaches for cancer prevention.
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Affiliation(s)
- Katie E J Hann
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Madeleine Freeman
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Lindsay Fraser
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Saskia C Sanderson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Belinda Rahman
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Lucy Side
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Sue Gessler
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK.
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Lunsford NB, Sapsis KF, Smither B, Reynolds J, Wilburn B, Fairley T. Young Women's Perceptions Regarding Communication with Healthcare Providers About Breast Cancer, Risk, and Prevention. J Womens Health (Larchmt) 2017; 27:162-170. [PMID: 28472603 DOI: 10.1089/jwh.2016.6140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women younger than 45 years old have lower rates of breast cancer, but higher risk of recurrence and mortality after a cancer diagnosis. African American women are at risk for early onset and increased mortality; Ashkenazi Jewish women are at risk for genetic mutations leading to breast and ovarian cancer. Although younger women are encouraged to talk to doctors about their family history, little is known about these discussions. MATERIALS AND METHODS In 2015, 167 women aged 18-44 years participated in 20 focus groups segmented by geographic location, age, race/ethnicity, and family history of breast and ovarian cancer. Transcript data were analyzed using NVivo 10 software. RESULTS Although the majority of women talked to their doctor about breast and ovarian cancer, these conversations were brief and unsatisfying due to a lack of detail. Topics included family history, breast cancer screening, and breast self-examination. Some women with and without family history reported that healthcare providers offered screening and early detection advice based on their inquiries. However, few women took action or changed lifestyle behaviors with the intent to reduce risk as a result of the conversations. CONCLUSIONS Conversations with young women revealed missed opportunities to: enhance patient-provider communication and increase knowledge about breast cancer screening and surveillance for higher risk patients. Physicians, allied health professionals, and the public health community can better assist women in getting accurate and timely information about breast and ovarian cancer, understanding their family history to determine risk, and increasing healthy behaviors.
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Affiliation(s)
- Natasha Buchanan Lunsford
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Karena F Sapsis
- 2 Office on Smoking and Health, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Betsy Smither
- 3 Oak Ridge Associated Universities , Oak Ridge, Tennessee
| | | | - Ben Wilburn
- 3 Oak Ridge Associated Universities , Oak Ridge, Tennessee
| | - Temeika Fairley
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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Fogel AL, Jaju PD, Li S, Halpern-Felsher B, Tang JY, Sarin KY. Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk. J Am Acad Dermatol 2017; 76:829-835.e1. [PMID: 28087134 DOI: 10.1016/j.jaad.2016.11.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 10/18/2016] [Accepted: 11/20/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing. OBJECTIVES The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing. METHODS We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective. RESULTS We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001). LIMITATIONS The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias. CONCLUSION The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing.
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Affiliation(s)
- Alexander L Fogel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Prajakta D Jaju
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.
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Adams I, Christopher J, Williams KP, Sheppard VB. What Black Women Know and Want to Know About Counseling and Testing for BRCA1/2. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:344-52. [PMID: 25301325 PMCID: PMC4393763 DOI: 10.1007/s13187-014-0740-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Black women are just as likely to have hereditary breast cancer mutations as White women, yet their participation in genetic counseling and testing is substantially lower. This study sought to describe Black women's awareness and perceptions of BRCA1/2 testing and to identify barriers and motivators to seeking BRCA1/2 services. Fifty intercept interviews were conducted with Black women in public places (a professional women's basketball game, a grocery store, a faith-based community event, and the waiting area at a breast care clinic) in Washington, DC. More than half of the women (54%) were aware that genetic tests to determine risk for certain breast and ovarian cancers exist, but the majority (88%) had never heard of BRCA1/2, specifically. After hearing a description of BRCA1/2 genetic markers, 82% stated that they would agree to BRCA1/2 testing if it was offered to them. Perceived advantages of testing included cancer prevention and the ability to share information with family members. Perceived disadvantages included emotional distress associated with identification of the mutation and the potential misuse of results to deny healthcare or employment. Physician recommendation, self-care, and known family history were among the motivators for testing. Women listed possible media and venues for intervention. In spite of low rates of BRCA1/2 testing in the Black community, women in this sample were open to the idea. Interventions that address barriers and include cultural tailoring are necessary.
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Affiliation(s)
- Inez Adams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 401 Park Dr., Room 403-E, Boston, Massachusetts 02215
| | - Juleen Christopher
- Center for Innovative Kidney Care, Minneapolis VA Health Care System Nephrology Section/Medicine Service. One Veterans Drive, Minneapolis, MN 55417
| | - Karen Patricia Williams
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 626 E. Fee Hall East Lansing, MI 4882
| | - Vanessa B. Sheppard
- Department of Oncology, Breast Cancer Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100. Washington DC 20007
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14
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Jagsi R, Griffith KA, Kurian AW, Morrow M, Hamilton AS, Graff JJ, Katz SJ, Hawley ST. Concerns about cancer risk and experiences with genetic testing in a diverse population of patients with breast cancer. J Clin Oncol 2015; 33:1584-91. [PMID: 25847940 DOI: 10.1200/jco.2014.58.5885] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate preferences for and experiences with genetic testing in a diverse cohort of patients with breast cancer identified through population-based registries, with attention to differences by race/ethnicity. METHODS We surveyed women diagnosed with nonmetastatic breast cancer from 2005 to 2007, as reported to the SEER registries of metropolitan Los Angeles and Detroit, about experiences with hereditary risk evaluation. Multivariable models evaluated correlates of a strong desire for genetic testing, unmet need for discussion with a health care professional, and receipt of testing. RESULTS Among 1,536 patients who completed the survey, 35% expressed strong desire for genetic testing, 28% reported discussing testing with a health care professional, and 19% reported test receipt. Strong desire for testing was more common in younger women, Latinas, and those with family history. Minority patients were significantly more likely to have unmet need for discussion (failure to discuss genetic testing with a health professional when they had a strong desire for testing): odds ratios of 1.68, 2.44, and 7.39 for blacks, English-speaking Latinas, and Spanish-speaking Latinas compared with whites, respectively. Worry in the long-term survivorship period was higher among those with unmet need for discussion (48.7% v 24.9%; P <.001). Patients who received genetic testing were younger, less likely to be black, and more likely to have a family cancer history. CONCLUSION Many patients, especially minorities, express a strong desire for genetic testing and may benefit from discussion to clarify risks. Clinicians should discuss genetic risk even with patients they perceive to be at low risk, as this may reduce worry.
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Affiliation(s)
- Reshma Jagsi
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ.
| | - Kent A Griffith
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Allison W Kurian
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Monica Morrow
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Ann S Hamilton
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - John J Graff
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Steven J Katz
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Sarah T Hawley
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
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Bodurtha JN, McClish D, Gyure M, Corona R, Krist AH, Rodríguez VM, Maibauer AM, Borzelleca J, Bowen DJ, Quillin JM. The KinFact intervention - a randomized controlled trial to increase family communication about cancer history. J Womens Health (Larchmt) 2014; 23:806-16. [PMID: 25321314 PMCID: PMC4195404 DOI: 10.1089/jwh.2014.4754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Knowing family history is important for understanding cancer risk, yet communication within families is suboptimal. Providing strategies to enhance communication may be useful. METHODS Four hundred ninety women were recruited from urban, safety-net, hospital-based primary care women's health clinics. Participants were randomized to receive the KinFact intervention or the control handout on lowering risks for breast/colon cancer and screening recommendations. Cancer family history was reviewed with all participants. The 20-minute KinFact intervention, based in communication and behavior theory, included reviewing individualized breast/colon cancer risks and an interactive presentation about cancer and communication. Study outcomes included whether participants reported collecting family history, shared cancer risk information with relatives, and the frequency of communication with relatives. Data were collected at baseline, 1, 6, and 14 months. RESULTS Overall, intervention participants were significantly more likely to gather family cancer information at follow-up (odds ratio [OR]: 2.73; 95% confidence interval [CI]: 2.01, 3.71) and to share familial cancer information with relatives (OR: 1.85; 95% CI: 1.37, 2.48). Communication frequency (1=not at all; 4=a lot) was significantly increased at follow-up (1.67 vs. 1.54). Differences were not modified by age, race, education, or family history. However, effects were modified by pregnancy status and genetic literacy. Intervention effects for information gathering and frequency were observed for nonpregnant women but not for pregnant women. Additionally, intervention effects were observed for information gathering in women with high genetic literacy, but not in women with low genetic literacy. CONCLUSIONS The KinFact intervention successfully promoted family communication about cancer risk. Educating women to enhance their communication skills surrounding family history may allow them to partner more effectively with their families and ultimately their providers in discussing risks and prevention.
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Affiliation(s)
- Joann N. Bodurtha
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donna McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Maria Gyure
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alexander H. Krist
- Department of Family Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Vivian M. Rodríguez
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alisa M. Maibauer
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Joseph Borzelleca
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Deborah J. Bowen
- Department of Community Health Sciences, Boston University, Boston, Massachusetts
| | - John M. Quillin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
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16
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Sweeny K, Ghane A, Legg AM, Huynh HP, Andrews SE. Predictors of genetic testing decisions: a systematic review and critique of the literature. J Genet Couns 2014; 23:263-88. [PMID: 24719248 DOI: 10.1007/s10897-014-9712-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
Genetic testing is increasingly available in medical settings and direct-to-consumer. However, the large and growing literature on genetic testing decisions is rife with conflicting findings, inconsistent methodology, and uneven attention across test types and across predictors of genetic testing decisions. Existing reviews of the literature draw broad conclusions but sacrifice nuanced analysis that with a closer look reveals far more inconsistency than homogeny across studies. The goals of this paper are to provide a systematic review of the empirical work on predictors of genetic testing decisions, highlight areas of consistency and inconsistency, and suggest productive directions for future research. We included all studies that provided quantitative analysis of subjective (e.g., perceived risk, perceived benefits of testing) and/or objective (e.g., family history, sociodemographic variables) predictors of genetic testing interest, intentions, or uptake, which produced a sample of 115 studies. From this review, we conclude that self-reported and test-related (as opposed to disorder-related or objective) predictors are relatively consistent across studies but that theoretically-driven efforts to examine testing interest across test types are sorely needed.
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Affiliation(s)
- Kate Sweeny
- Department of Psychology, University of California, 900 University Ave., Riverside, CA, 92521, USA,
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17
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Kelly KM, Ellington L, Schoenberg N, Agarwal P, Jackson T, Dickinson S, Abraham J, Paskett ED, Leventhal H, Andrykowski M. Linking genetic counseling content to short-term outcomes in individuals at elevated breast cancer risk. J Genet Couns 2014; 23:838-48. [PMID: 24671341 DOI: 10.1007/s10897-014-9705-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy, West Virginia University, Morgantown, WV, USA,
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18
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Ricks LJ, Ewing A, Thompson N, Harrison B, Wilson B, Richardson F, Carter-Nolan P, Spencer C, Laiyemo A, Williams C. Family history of cancer associated with breast tumor clinicopathological features. J Community Genet 2014; 5:233-40. [PMID: 24424917 DOI: 10.1007/s12687-013-0180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/12/2013] [Indexed: 01/19/2023] Open
Abstract
Hereditary breast cancers have unique clinicopathological characteristics. Therefore, the objective of this study was to establish the relationship between self-reported family history of cancer and clinicopathological features in breast cancer patients from Washington, DC. Data on incident breast cancer cases from 2000 to 2010 were obtained from the Washington, DC Cancer Registry. Variables such as estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptor status, as well as stage and grade, were analyzed in those that self-reported with (n = 1,734) and without a family history of cancer (n = 1,712). The breast cancer molecular subtypes were compared when ER, PR, and HER2 statuses were available. Furthermore, tumor characteristics were compared by race/ethnicity. Regression and chi-square analyses were performed. A report of family history was associated with age (OR = 1.27 95 % CI: 1.09-1.48; p < 0.0001), high grade tumors (OR = 1.29 95 % CI: 1.05-1.58; p = 0.02), and having ER and PR negative breast cancer (OR = 1.26 95 % CI: 1.02-1.57; p = 0.029). When tumor characteristics were compared by race/ethnicity, those that self-reported as African American with a family history had a higher frequency of ER negative tumors (OR = 1.51 95 % CI: 1.09-2.08; p = 0.008), PR negative tumors (OR = 1.46 95 % CI: 1.09-1.94; p = 0.028), grade 3 tumors (OR = 1.42 95 % CI: 1.05-1.93; p < 0.0001), and ER/PR negative tumors (OR = 1.5 95 % CI: 1.088-2.064; p = 0.01). These results suggest that a positive family history of cancer in African Americans should increase suspicions of hereditary cancer. Therefore, behavioral risk reduction activities, such as collecting a family history, may reduce late stage diagnosis and cancer mortality.
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Affiliation(s)
- Luisel J Ricks
- Department of Pediatrics and Child Health, Division of Genetics, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC, 20060, USA,
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19
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Sheppard VB, Graves KD, Christopher J, Hurtado-de-Mendoza A, Talley C, Williams KP. African American women's limited knowledge and experiences with genetic counseling for hereditary breast cancer. J Genet Couns 2013; 23:311-22. [PMID: 24186304 DOI: 10.1007/s10897-013-9663-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/02/2013] [Indexed: 12/14/2022]
Abstract
Genetic counseling and testing for hereditary breast cancer have the potential benefit of early detection and early interventions in African American women. However, African American women have low use of these services compared to White women. We conducted two focus groups with African American women diagnosed with breast cancer (affected group, n = 13) and women with at least one first-degree relative with breast/ovarian cancer (unaffected group, n = 8). A content analysis approach was employed to analyze interview data. Breast cancer survivors had more knowledge about genetic counseling and testing than participants who were unaffected with cancer. However, knowledge about genetic counseling was limited in both groups. Barriers to pursuing genetic counseling and testing included poor understanding of the genetic counseling and testing process, fear of carrying the mutation, concerns about discrimination, and cost. Motivators to participate in genetic counseling and testing included desire to help family members, insurance coverage, and potential of benefiting the larger African American community. Education efforts are needed to increase genetic counseling and testing awareness in the African American community.
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Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program, Lombardi Cancer Center, Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA,
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Peters SA, Laham SM, Pachter N, Winship IM. The future in clinical genetics: affective forecasting biases in patient and clinician decision making. Clin Genet 2013; 85:312-7. [PMID: 23952534 DOI: 10.1111/cge.12255] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
When clinicians facilitate and patients make decisions about predictive genetic testing, they often base their choices on the predicted emotional consequences of positive and negative test results. Research from psychology and decision making suggests that such predictions may often be biased. Work on affective forecasting-predicting one's future emotional states-shows that people tend to overestimate the impact of (especially negative) emotional events on their well-being; a phenomenon termed the impact bias. In this article, we review the causes and consequences of the impact bias in medical decision making, with a focus on applying such findings to predictive testing in clinical genetics. We also recommend strategies for reducing the impact bias and consider the ethical and practical implications of doing so.
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Affiliation(s)
- S A Peters
- Royal Melbourne Hospital, Melbourne, Australia
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21
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Sheppard VB, Mays D, LaVeist T, Tercyak KP. Medical mistrust influences black women's level of engagement in BRCA 1/2 genetic counseling and testing. J Natl Med Assoc 2013; 105:17-22. [PMID: 23862292 DOI: 10.1016/s0027-9684(15)30081-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical evidence supports the value of BRCA1/2 genetic counseling and testing for managing hereditary breast and ovarian cancer risk; however, BRCA1/2 genetic counseling and testing are underutilized among black women, and reasons for low use remain elusive. We examined the potential influence of sociocultural factors (medical mistrust, concerns about genetic discrimination) on genetic counseling and testing engagement in a sample of 100 black women at increased risk for carrying a BRCA1/2 mutation. Eligible participants fell into 1 of 3 groups: (1) healthy women with at least 1 first-degree relative affected by breast and/or ovarian cancer, (2) women diagnosed with breast cancer at age less than or equal to 50 years; and (3) women diagnosed with breast and/or ovarian cancer at age greater than or equal to 50 years with either 1 first-degree relative or 2 second-degree relatives with breast and/or ovarian cancer. Participants were recruited from clinical anid community settings and completed a semistructured interview. Study variable relationships were examined using bivariate tests and multivariate regression analysis. As expected, genetic counseling and testing engagement among this sample was low (28%). After accounting for;sociodemographic factors and self-efficacy (beta=0.37, p<.001), women with higher medical mistrust had lower genetic counseling and testing engagement (beta=-0.26, p<.01). Community-level and individual interventions are needed to improve utilization of genetic counseling and testing among underserved women. Along with trust building between patients and providers, strategies should enhance women's personal confidence. The impact of medical mistrust on the realization of the benefits of personalized medicine in minority populations should be further examined in future studies.
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Affiliation(s)
- Vanessa B Sheppard
- Cancer Control Program, Lombardi Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia 20007, USA.
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22
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Mays D, Sharff ME, DeMarco TA, Williams B, Beck B, Sheppard VB, Peshkin BN, Eng-Wong J, Tercyak KP. Outcomes of a systems-level intervention offering breast cancer risk assessments to low-income underserved women. Fam Cancer 2013; 11:493-502. [PMID: 22711611 DOI: 10.1007/s10689-012-9541-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hereditary breast and ovarian cancer risk assessments (CRAs) are underutilized by low-income and racial/ethnic minority women, potentially exacerbating cancer-related disparities observed within these populations. We deployed and evaluated a systems-level intervention designed to identify patients potentially at-risk for hereditary breast/ovarian cancer, refer them for CRAs, and facilitate CRA utilization at an urban community-based breast health care center. Cancer family history forms were completed by patients seen at the center during an 18-month period and reviewed by staff for CRA eligibility against published referral criteria. A patient navigator educated eligible patients about the benefits of CRA, navigating interested patients to this service. CRA-specific patient interest and utilization outcomes are reported. In total, 94.7 % of all patients (n = 2,436) completed forms and 65 patients (2.7 %) met CRA eligibility criteria. Most eligible patients (72.3 %) were interested in CRA. Interested patients had a greater risk for hereditary breast/ovarian cancer (i.e., more affected relatives, greater objective risk scores) than uninterested patients: 57.4 % scheduled a CRA appointment and 51.9 % of scheduled patients utilized CRAs. Patients scheduling a CRA were contacted in less time and required fewer follow-up contacts by the patient navigator, and were more likely to be African American, than those who declined a CRA or were lost to follow-up (all p's ≤ .05). The systems-level intervention successfully identified patients eligible for CRA and linked interested and at-risk patients with CRA resources. More intensive patient navigation addressing the unique barriers encountered within this population may be required to enhance utilization.
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Affiliation(s)
- Darren Mays
- Division of Health Outcomes and Health Behaviors, Department of Oncology, Lombardi Comprehensive Cancer, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
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23
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Vadaparampil ST, Azzarello L, Pickard J, Jacobsen PB. Intention to Obtain Genetic Testing for Melanoma among Individuals at Low to Moderate Risk for Hereditary Melanoma. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2007.10598960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Susan T. Vadaparampil
- a College of Medicine , University of South Florida, H. Lee Moffitt Cancer Center and Research Institute Tampa , FL , 12902
| | - Lora Azzarello
- b H. Lee Moffitt Cancer Center , Research Institute Tampa , FL
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Interest and attitudes of patients, cancer physicians, medical students and cancer researchers towards a spectrum of genetic tests relevant to breast cancer patients. Breast 2012; 22:47-52. [PMID: 22560561 DOI: 10.1016/j.breast.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/21/2012] [Accepted: 04/11/2012] [Indexed: 11/21/2022] Open
Abstract
The perspectives of patients and healthcare professionals towards breast cancer genetic tests that are becoming increasingly available is unexplored in Asians. We surveyed the interest and attitudes of 200 breast cancer patients, 67 cancer physicians, 485 medical students and cancer researchers towards three genetic tests, BRCA1/2 mutation, CYP2D6 genotype and Oncotype DX testing, using hypothetical scenarios. Approximately 60% of patients expressed initial interest in each genetic test, although the majority reversed their decisions once test limitations were conveyed, with <15% maintaining interest in each test. Cancer physicians were most likely to recommend BRCA1/2 mutation testing (73%) and least likely to recommend CYP2D6 genotyping (12%), while patients were more likely to choose Oncotype DX testing (28%) over CYP2D6 (21%) and BRCA1/2 testing (15%). Cost concerns, low educational level and lack of prior awareness of genetic testing were the main barriers against breast cancer genetic testing among Asian patients.
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Haga SB, Tindall G, O'Daniel JM. Public perspectives about pharmacogenetic testing and managing ancillary findings. Genet Test Mol Biomarkers 2011; 16:193-7. [PMID: 22047505 DOI: 10.1089/gtmb.2011.0118] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Pharmacogenetic (PGx) tests are intended to improve therapeutic outcomes through predicting a patient's likelihood to respond to or experience an adverse effect from a specific treatment. In addition, PGx testing may also generate ancillary, or incidental, disease information unrelated to the purpose for which the test was ordered. To assess public attitudes toward PGx testing, ancillary disease risk information and related clinical issues, we conducted a series of focus groups. RESULTS Forty-five individuals recruited from Durham, NC, participated in four focus groups. Overall, participants were enthusiastic about PGx testing, though expressed concerns about privacy, confidentiality, and psychological harms associated with ancillary information. Focus group participants believed that physicians had a responsibility to disclose ancillary risk information, but were concerned about managing and coping with unexpected disease risk information. CONCLUSION We find that participants welcomed the integration of PGx testing into therapeutic decision-making. Public concerns about PGx testing and ancillary information specifically centered on personal implications of learning such additional information, suggesting that patient-provider discussion of the benefits and risks of testing will be necessary until public familiarity with these tests increases.
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Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences and Policy, Duke University, Durham, North Carolina 27708, USA.
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Providers' perceptions and practices regarding BRCA1/2 genetic counseling and testing in African American women. J Genet Couns 2011; 20:674-89. [PMID: 21822773 DOI: 10.1007/s10897-011-9396-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 07/13/2011] [Indexed: 01/11/2023]
Abstract
We examined healthcare providers' perceptions of genetic counseling and testing in African American women at moderate to high-risk of carrying a BRCA1/2 mutation. We conducted 20 in-depth interviews with genetic counselors (n = 5), medical oncologists (n = 8), obstetrician/gynecologists (n = 2) and surgeons (n = 5). Interviews were audiotaped, transcribed and independently coded by two individuals using a content analysis approach. Seven themes emerged relevant to providers' perceptions of African American women's use of BRCA1/2 genetic services: access factors, cultural beliefs and preferences, effects of testing, patient motivators for genetic counseling and testing, patient-provider communication, reasons for provider referral, and reasons for patient refusal. Providers identified individual- and system-level barriers to African American women's use of genetic services, including lack of follow-up after referrals to genetic specialists and challenges to obtaining financial coverage for under- and uninsured high-risk women. Results have implications for physician and patient education regarding appropriate referrals to and uptake of genetic services in at-risk African American women.
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Vadaparampil ST, Quinn GP, Dutil J, Puig M, Malo TL, McIntyre J, Perales R, August EM, Closser Z. A pilot study of knowledge and interest of genetic counseling and testing for hereditary breast and ovarian cancer syndrome among Puerto Rican women. J Community Genet 2011; 2:211-21. [PMID: 22109874 DOI: 10.1007/s12687-011-0058-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 06/30/2011] [Indexed: 12/31/2022] Open
Abstract
This study explored baseline levels of knowledge and attitude toward genetic testing (GT) for hereditary breast and ovarian cancer among Puerto Rican women. A secondary aim was to evaluate whether these factors differed between respondents in Puerto Rico and Tampa. Puerto Rican women with a personal or family history of breast or ovarian cancer who live in Puerto Rico (n = 25) and Tampa (n = 20) were interviewed. Both groups were interested in obtaining GT; women living in Puerto Rico were more likely to report they would get GT within 6 months (p = 0.005). The most commonly cited barrier was cost; the most commonly cited facilitator was provider recommendation. There was no difference in overall knowledge between Tampa (M = 5.15, SD = 1.63) and Puerto Rico (M = 5.00, SD = 1.87) participants (p = 0.78). Involving health care providers in recruitment and highlighting that GT may be available at minimal or no cost in the USA and Puerto Rico may facilitate participation.
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Affiliation(s)
- Susan T Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive, MRC CANCONT, Tampa, FL, 33612, USA,
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Perez GK, Cruess DG, Cruess S, Brewer M, Stroop J, Schwartz R, Greenstein R. Attitudes toward direct-to-consumer advertisements and online genetic testing among high-risk women participating in a hereditary cancer clinic. JOURNAL OF HEALTH COMMUNICATION 2011; 16:607-628. [PMID: 21432710 DOI: 10.1080/10810730.2011.551993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Genetic testing for the breast cancer genes 1/2 (BRCA 1/2) has helped women determine their risk of developing breast and ovarian cancer. As interest in genetic testing has grown, companies have created strategies to disseminate information about testing, including direct-to-consumer advertising (DTCA) and online genetic testing. This study examined attitudes toward DTCA and online testing for BRCA among 84 women at a high-risk clinic as well as additional factors that may be associated with these attitudes, such as personal and familial cancer history, cancer worry and risk perception, and history with genetic testing/counseling. Results showed that the majority of the women held favorable attitudes toward DTCA for BRCA testing but did not support online testing. Factors such as familial ovarian cancer, cancer worry, and satisfaction with genetic counseling/testing were associated with positive attitudes toward DTCA, whereas personal breast cancer history was related to negative attitudes. The findings suggest that women may view DTCA as informational but rely on physicians for help in their decision to undergo testing, and also suggest that cancer history may affect women's acceptance of DTCA and genetic testing.
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Affiliation(s)
- Giselle K Perez
- Department of Psychology, University of Connecticut, Storrs, Connecticut 06269-1020, USA.
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Sussner KM, Edwards TA, Thompson HS, Jandorf L, Kwate NO, Forman A, Brown K, Kapil-Pair N, Bovbjerg DH, Schwartz MD, Valdimarsdottir HB. Ethnic, racial and cultural identity and perceived benefits and barriers related to genetic testing for breast cancer among at-risk women of African descent in New York City. Public Health Genomics 2011; 14:356-70. [PMID: 21540561 DOI: 10.1159/000325263] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Due to disparities in the use of genetic services, there has been growing interest in examining beliefs and attitudes related to genetic testing for breast and/or ovarian cancer risk among women of African descent. However, to date, few studies have addressed critical cultural variations among this minority group and their influence on such beliefs and attitudes. METHODS We assessed ethnic, racial and cultural identity and examined their relationships with perceived benefits and barriers related to genetic testing for cancer risk in a sample of 160 women of African descent (49% self-identified African American, 39% Black-West Indian/Caribbean, 12% Black-Other) who met genetic risk criteria and were participating in a larger longitudinal study including the opportunity for free genetic counseling and testing in New York City. All participants completed the following previously validated measures: (a) the multi-group ethnic identity measure (including ethnic search and affirmation subscales) and other-group orientation for ethnic identity, (b) centrality to assess racial identity, and (c) Africentrism to measure cultural identity. Perceived benefits and barriers related to genetic testing included: (1) pros/advantages (including family-related pros), (2) cons/disadvantages (including family-related cons, stigma and confidentiality concerns), and (3) concerns about abuses of genetic testing. RESULTS In multivariate analyses, several ethnic identity elements showed significant, largely positive relationships to perceived benefits about genetic testing for breast and/or ovarian cancer risk, the exception being ethnic search, which was positively associated with cons/disadvantages, in general, and family-related cons/disadvantages. Racial identity (centrality) showed a significant association with confidentiality concerns. Cultural identity (Africentrism) was not related to perceived benefits and/or barriers. CONCLUSIONS Ethnic and racial identity may influence perceived benefits and barriers related to genetic testing for breast and/or ovarian cancer risk among at-risk women of African descent. Genetic counseling services may want to take into account these factors in the creation of culturally-appropriate services which best meet the needs of this heterogenous population.
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Affiliation(s)
- K M Sussner
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Haga SB, O'Daniel JM, Tindall GM, Lipkus IR, Agans R. Survey of US public attitudes toward pharmacogenetic testing. THE PHARMACOGENOMICS JOURNAL 2011; 12:197-204. [PMID: 21321582 PMCID: PMC3139751 DOI: 10.1038/tpj.2011.1] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To assess public attitudes and interest in pharmacogenetic (PGx) testing, we conducted a random-digit-dial telephone survey of US adults, achieving a response rate of 42% (n=1139). Most respondents expressed interest in PGx testing to predict mild or serious side effects (73±3.29 and 85±2.91%, respectively), guide dosing (91%) and assist with drug selection (92%). Younger individuals (aged 18-34 years) were more likely to be interested in PGx testing to predict serious side effects (vs aged 55+ years), as well as Whites, those with a college degree, and who had experienced side effects from medications. However, most respondents (78±3.14%) were not likely to have a PGx test if there was a risk that their DNA sample or test result could be shared without their permission. Given differences in interest among some groups, providers should clearly discuss the purpose of testing, alternative testing options (if available) and policies to protect patient privacy and confidentiality.
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Affiliation(s)
- S B Haga
- Institute for Genome Sciences and Policy, Duke University, Durham, NC 27708, USA.
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Christianson CA, Powell KP, Hahn SE, Bartz D, Roxbury T, Blanton SH, Vance JM, Pericak-Vance M, Telfair J, Henrich VC. Findings from a community education needs assessment to facilitate the integration of genomic medicine into primary care. Genet Med 2011; 12:587-93. [PMID: 20860071 DOI: 10.1097/gim.0b013e3181ed3f97] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To assess the lay public's knowledge of, and beliefs about, genetics and genetic testing to create an educational initiative that promotes acceptance and utilization of genomic medicine in primary health care. METHODS A telephone survey of English-speaking adults in Guilford County, North Carolina was conducted in 2006 to identify community members' educational needs regarding genetics and genetic testing. RESULTS Most respondents recognized the connection between family history and disease risk. A majority did not appear to know about: (1) basic principles of inheritance, (2) laws prohibiting genetic discrimination, and (3) the availability and limitations of genetic tests. About 25% thought that they could not reduce their risk if they have a genetic predisposition for disease. Knowledge level was affected by education, experience, age, and race. CONCLUSION If primary care providers use family history as a risk assessment tool, community education programs must address (1) the collection of family health history, (2) legislation regarding genetic nondiscrimination, (3) benefits and limitations of existing genetic tests, and (4) genetic determinism. Programs emphasizing practical, "how to" information can be targeted to individuals likely to collect family history information and address misperceptions about discrimination, testing, and determinism.
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Affiliation(s)
- Carol A Christianson
- Center for Biotechnology, Genomics and Health Research, The University of North Carolina at Greensboro, North Carolina, USA.
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Pal T, Rocchio E, Garcia A, Rivers D, Vadaparampil S. Recruitment of Black Women for a Study of Inherited Breast Cancer Using a Cancer Registry–Based Approach. Genet Test Mol Biomarkers 2011; 15:69-77. [DOI: 10.1089/gtmb.2010.0098] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Tuya Pal
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Epidemiology and Cancer Genetics, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Erin Rocchio
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Ana Garcia
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Desiree Rivers
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Susan Vadaparampil
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Australian women’s awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk. Cancer Causes Control 2010; 21:2231-9. [DOI: 10.1007/s10552-010-9643-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
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Permuth-Wey J, Vadaparampil S, Rumphs A, Kinney AY, Pal T. Development of a culturally tailored genetic counseling booklet about hereditary breast and ovarian cancer for Black women. Am J Med Genet A 2010; 152A:836-45. [PMID: 20358592 DOI: 10.1002/ajmg.a.33187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Printed educational materials (PEM) can serve as important tools to enhance and reinforce information presented during genetic counseling (GC) for BRCA1/2 testing, yet few such materials have been specifically developed for the Black community. The goal of the current study was to develop a BRCA1/2 genetic education booklet for Black women at increased risk for hereditary breast and ovarian cancer (HBOC). Investigators identified available PEM about BRCA1/2 targeted toward Blacks. To obtain possible perspectives of the target population regarding modified and newly developed materials, a Community Advisory Panel (CAP) comprising breast cancer survivors, advocates, and community leaders was convened. While the CAP felt PEM were an important adjunct to GC, the panel recommended developing materials that were more personalized and relevant to Black women. A 12-page booklet that follows the flow of a standard GC session was developed; it includes a limited amount of technical information, incorporates familiar terms and images to describe key concepts, and contains vignettes and photographs of Black women. Upon review of the newly developed booklet, CAP members agreed their input had been well implemented, and only had minor suggestions. The booklet is currently being used in a population-based study of BRCA1/2 mutations among Black women diagnosed with early-onset breast cancer. Involving members of the target community is critical to the development of culturally tailored PEM. Further evaluation of the utility of our booklet in increasing awareness and understanding of HBOC and promoting informed decision-making regarding genetic testing and medical management among Black women is needed.
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Affiliation(s)
- Jennifer Permuth-Wey
- Department of Epidemiology and Genetics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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Vadaparampil ST, Pal T. Updating and refining a study brochure for a cancer registry-based study of BRCA mutations among young African American breast cancer patients: lessons learned. J Community Genet 2010; 1:63-71. [PMID: 22460206 DOI: 10.1007/s12687-010-0010-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 05/05/2010] [Indexed: 01/03/2023] Open
Abstract
The aim of the present study was to update, refine, and evaluate a study brochure to promote participation in a population-based study of BRCA mutations among AA women with a personal history of early-onset breast cancer. A multi-step approach was used to develop this brochure and included: (1) feedback from community members (through a Community Advisory Panel (CAP)) to develop and refine the study brochure, (2) pilot testing of materials with the target audience, and (3) review of pilot testing results with the CAP. Based on the feedback received at each step, the study brochure was refined. In phase 1, the major changes included emphasizing the concept of leaving a legacy and family, using the terms Black and women of color, and use of patient vignettes and photos. In phase 2, attraction and cultural acceptability were identified as two areas for improvement in the study brochure. These results demonstrate that involvement of community members and target study population in the development of a study-specific brochure can provide invaluable feedback to optimize recruitment strategies. This approach can be readily adapted to develop study recruitment materials for individuals from a variety of cultural and ethnic backgrounds.
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Affiliation(s)
- Susan T Vadaparampil
- Division of Cancer Prevention and Control, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA,
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Quinn GP, McIntyre J, Vadaparampil ST. Preferences for hereditary breast and ovarian cancer information among Mexican, Cuban and Puerto Rican women at risk. Public Health Genomics 2010; 14:248-58. [PMID: 20150724 DOI: 10.1159/000284582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the preferences of at-risk Hispanic women to gain information on hereditary breast and ovarian cancer (HBOC). AIMS This study sought to qualitatively explore preferences for HBOC information among at-risk Mexican, Puerto Rican and Cuban women and to pilot a mock brochure aimed at Hispanic women. METHODS Hispanic women aged 18-65 years with a personal or family history of breast or ovarian cancer participated in a semistructured interview. Data were analyzed using a combination of open-coding and content analysis. RESULTS Fifty-three women participated in the study. For the majority of content areas, there were no major differences between the subethnicities. All women reported discussing cancer with a doctor after a family member had been diagnosed and discussing cancer within their families; however, the content of the discussion varied. Cuban and Puerto Rican women reported using the Internet routinely for health care information while Mexican women said they did not have access to computers and did not use them. All women liked the content and photos in the brochure but Mexican women thought the reading level was too high. Preferences for the spokesperson focused on the need for Spanish-speaking health care providers. CONCLUSIONS While the data show some similarities, such as patterns of cancer discussion and appreciation of the mock brochure, there were differences between the groups on information preferences. In designing HBOC education information for Hispanic audiences, it is important to consider varied channels for dissemination and preferences for specific types of information across subethnicities.
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Affiliation(s)
- Gwendolyn P Quinn
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA
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Forman AD, Hall MJ. Influence of race/ethnicity on genetic counseling and testing for hereditary breast and ovarian cancer. Breast J 2009; 15 Suppl 1:S56-62. [PMID: 19775331 DOI: 10.1111/j.1524-4741.2009.00798.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Risk assessment coupled with genetic counseling and testing for the cancer predisposition genes BRCA1 and BRCA2 (BRCA1/2) has become an integral element of comprehensive patient evaluation and cancer risk management in the United States for individuals meeting high-risk criteria for hereditary breast and ovarian cancer (HBOC). For mutation carriers, several options for risk modification have achieved substantial reductions in future cancer risk. However, several recent studies have shown lower rates of BRCA1/2 counseling and testing among minority populations. Here, we explore the role of race/ethnicity in cancer risk assessment, genetic counseling and genetic testing for HBOC and the BRCA1/2 cancer predisposition genes. Barriers to genetic services related to race/ethnicity and underserved populations, including socioeconomic barriers (e.g., time, access, geographic, language/cultural, awareness, cost) and psychosocial barriers (e.g., medical mistrust, perceived disadvantages to genetic services), as well as additional barriers to care once mutation carriers are identified, will be reviewed.
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Affiliation(s)
- Andrea D Forman
- Familial Risk Assessment Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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Halbert CH, Kessler LJ, Mitchell E. Genetic Testing for Inherited Breast Cancer Risk in African Americans. Cancer Invest 2009; 23:285-95. [PMID: 16100940 DOI: 10.1081/cnv-58819] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
As genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations is increasingly integrated into the clinical management of high-risk women, it will be important to understand barriers and motivations for genetic counseling among women from underserved minority groups to ensure equitable access to these services. Therefore, the purpose of this review was to synthesize literature on knowledge and attitudes about genetic counseling and testing for inherited breast cancer risk in African Americans. We also review studies that evaluated genetic testing intentions in this population. We conducted a search of the PubMed database to identify studies related to BRCA1/2 testing in African Americans that were published between 1995 and 2003. Overall, studies have evaluated ethnic differences in knowledge and attitudes about genetic testing or have compared African American and Caucasian women in terms of genetic testing intentions. These studies have shown that knowledge about breast cancer genetics and exposure to information about the availability of testing is low among African Americans, whereas expectations about the benefits of genetic testing are endorsed highly. However, much less is known about the psychological and behavioral impact of genetic testing for BRCA1/2 mutations in African Americans. Additional research is needed to understand barriers and motivations for participating in genetic testing for inherited cancer risk in African Americans. The lack of studies on psychological functioning, cancer surveillance, and preventive behaviors following testing is a significant void; however, for these studies to be conducted, greater access to genetic counseling and testing in African Americans will be needed.
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Affiliation(s)
- Chanita Hughes Halbert
- Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Kinney AY, Simonsen SE, Baty BJ, Mandal D, Neuhausen SL, Seggar K, Holubkov R, Smith K. Acceptance of genetic testing for hereditary breast ovarian cancer among study enrollees from an African American kindred. Am J Med Genet A 2009; 140:813-26. [PMID: 16523520 PMCID: PMC2562369 DOI: 10.1002/ajmg.a.31162] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical availability of genetic testing for cancer predisposition genes is generating a major challenge for U.S. health care systems to provide relevant genetic services to underserved populations. Here we present rates of study enrollment and utilization of genetic testing in a research study on BRCA1 testing acceptance in one large kindred. We also present data on baseline access to genetic information as well as enabling and obstructing factors to study enrollment. The study population included female and male members of an African American kindred based in the rural southern United States with an identified BRCA1 mutation. A combination of quantitative and qualitative data were collected and analyzed. Of the 161 living, eligible, and locatable kindred members, 105 (65%) enrolled in the study. Family, personal, and educational motivations were the most commonly endorsed reasons for study participation. The most commonly cited reasons for refusal to participate in the study were: lack of interest, time constraints, and negative experiences with prior participation in genetic research. Eighty three percent of the participants underwent BRCA1 testing. In multiple logistic regression analysis, age 40-49 (odds ratio (OR) = 6.9; 95% confidence interval (CI) = 1.2-39.5), increased perceived risk of being a BRCA1 mutation carrier (OR = 4.1; 95% CI = 1.1-14.6), and high cancer genetics knowledge levels (OR = 1.5; 95% CI = 1.1-2.3) were associated with BRCA1 testing acceptance. The results of this study indicate that cognitive and demographic factors may influence genetic research participation and genetic testing decisions among African Americans who are at increased risk of carrying a deleterious BRCA1 mutation.
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Kelly KM, Ferketich AK, Sturm AC, Porter K, Sweet K, Kemp K, Schwirian P, Westman JA. Cancer risk and risk communication in urban, lower-income neighborhoods. Prev Med 2009; 48:392-6. [PMID: 19463493 DOI: 10.1016/j.ypmed.2009.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 01/16/2009] [Accepted: 01/16/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Family history of cancer is an important risk factor for the disease, and communicating with family and physicians about family history is critical to cancer risk assessment. This study examined cancer risk communication with family and physicians. METHODS A telephone interview was administered to randomly selected participants (n=217) from 5 urban, lower-income communities in 2006 and 2007. A large proportion of the population were minorities and of lower socio-economic status (47% African American, 43% incomes <$25,000). Most (76%) believed family history was important, and approximately half talked to their family (50%) or their physician (49%) about their cancer risk. RESULTS Respondents were equally likely as family members to initiate discussions about cancer risk, but respondents were more likely to initiate discussions with physicians. Logistic regression models were fit to talk to family, talk to physician, and perceived risk. In multivariable analysis, higher income and greater worry were associated with talking to family about risk, and higher income was associated with talking to physician about risk. Gender, family history and worry were associated with greater perceived risk. CONCLUSION Efforts to decrease income barriers to cancer risk communication are needed.
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Affiliation(s)
- Kimberly M Kelly
- Human Cancer Genetics, The Ohio State University, Columbus, OH 43210, USA.
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Holland ML, Huston A, Noyes K. Cost-effectiveness of testing for breast cancer susceptibility genes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:207-216. [PMID: 18647256 DOI: 10.1111/j.1524-4733.2008.00418.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Genetic mutations in breast cancer susceptibility genes BRCA1/2 are associated with an increased risk of breast/ovarian cancers. Cost-effective preventive measures are available for women who test positive. The objective of this study was to determine at what risk of mutation it is cost-effective to test women for BRCA1/2 mutations. METHODS A semi-Markov model accrued costs and quality-adjusted life years (QALYs) annually from the societal perspective. The estimates of health-care costs, life expectancy, likelihood of obtaining a mastectomy or oophorectomy, and patient preferences for treatment and certainty about their BRCA1/2 status were based on the literature. RESULTS At a 10% probability of mutation (the current guideline), the test strategy generated 22.9 QALYs over the lifetime and cost $118k, while the no-test strategy generated 22.7 QALYs and cost $117k. The incremental cost-effectiveness ratio of the test strategy was $9k and the differences between costs and effects were not substantial. The test strategy remained cost-effective to a probability of mutation of 0%, as long as utility gained from a negative test result was 0.006 or greater. These results were sensitive to the frequency of inconclusive test results and utility gain from a negative test result. CONCLUSIONS The costs and effectiveness of both the test and no-test strategies are very similar even when there is a small probability of mutation. Current guidelines, which can be used by insurance companies to refuse coverage, could deny some women a cost-effective approach. Further research to decrease the frequency of inconclusive results could improve the cost-effectiveness of this test.
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Affiliation(s)
- Margaret L Holland
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14620, USA.
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White MT. Making sense of genetic uncertainty: the role of religion and spirituality. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2009; 151C:68-76. [PMID: 19170081 PMCID: PMC2698435 DOI: 10.1002/ajmg.c.30196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article argues that to the extent that religious and spiritual beliefs can help people cope with genetic uncertainty, a limited spiritual assessment may be appropriate in genetic counseling. The article opens by establishing why genetic information is inherently uncertain and why this uncertainty can be medically, morally, and spiritually problematic. This is followed by a review of the range of factors that can contribute to risk assessments, including a few heuristics commonly used in responses to uncertainty. The next two sections summarize recent research on the diverse roles of religious and spiritual beliefs in genetic decisions and challenges to conducting spiritual assessments in genetic counseling. Based on these findings, religious and spiritual beliefs are posited as serving essentially as a heuristic that some people will utilize in responding to their genetic risks. In the interests of helping such clients make informed decisions, a limited spiritual assessment is recommended and described. Some of the challenges and risks associated with this limited assessment are discussed. Since some religious and spiritual beliefs can conflict with the values of medicine, some decisions will remain problematic.
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Affiliation(s)
- Mary T White
- Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH 45401-0927, USA.
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Simon MS, Petrucelli N. Hereditary breast and ovarian cancer syndrome : the impact of race on uptake of genetic counseling and testing. Methods Mol Biol 2009; 471:487-500. [PMID: 19109796 DOI: 10.1007/978-1-59745-416-2_25] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Breast cancer is a significant cause of morbidity and mortality in the United States. Although breast cancer is more common among White American (WA) women, incidence rates are higher among young African American (AA) women. Approximately 5-10% of all breast cancer can be accounted for by germline mutations in the breast cancer (BRCA)1 and BRCA2 genes responsible for hereditary breast and ovarian cancer (HBOC) syndrome. Although genetic counseling (GC) and genetic testing (GT) for HBOC have become widely accepted by the WA population, cancer genetic services are underused among AA. Many investigators have evaluated a wide spectrum of BRCA1 and BRCA2 mutations in the AA and African population with the possible identification of African founder mutations. Barriers to GC and GT include lack of knowledge and/or negative attitudes regarding genetics and genetics research, and concerns regarding the potential for racial discrimination. It is important for future research to focus on ways in which to eliminate barriers to GC and GT to alleviate disparity in the use of genetic services among high-risk AA women.
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Affiliation(s)
- Michael S Simon
- Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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Ceballos RM, Newcomb PA, Beasley JM, Peterson S, Templeton A, Hunt JR. Colorectal cancer cases and relatives of cases indicate similar willingness to receive and disclose genetic information. ACTA ACUST UNITED AC 2008; 12:415-20. [PMID: 18752450 DOI: 10.1089/gte.2008.0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Recent developments in genetic testing allow us to detect individuals with inherited susceptibility to some cancers. Genetic testing to identify carriers of cancer-related mutations may help lower risk by encouraging preventive behaviors and surveillance. This study assessed willingness of colon cancer cases and relatives to receive genetic information that may indicate an increased risk for cancer, to whom they would disclose genetic information, and whether receiving genetic test results may influence future prevention behaviors among individuals enrolled in the Seattle Colorectal Cancer Family Registry. METHODS Incident invasive colorectal cancer cases were identified from the Puget Sound Surveillance Epidemiology and End Results (SEER) registry. In 2007, a sequential sample of cases and relatives (n = 147) were asked to respond to a questionnaire addressing study aims. The questionnaire was administered during a baseline or 5-year follow-up interview. RESULTS Patterns of response to each statement were similar between colorectal cancer cases and relatives. Both colorectal cases (95%) and relatives (95%) reported willingness to receive genetic information. Nearly all participants would tell their doctor the results of a genetic test (99% of cases; 98% of relatives), and all married participants would tell their spouses. Cases (96%) anticipated being slightly more likely than relatives (90%) to change their cancer screening behavior, but this difference was not statistically significant (p = 0.33). CONCLUSIONS A high percentage of both colorectal cancer cases and relatives sampled from the Seattle Colorectal Cancer Family Registry are interested in identifying their genetic status, discussing their genetic status with their family and doctor, and adopting behavioral changes that may reduce cancer risk.
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Affiliation(s)
- Rachel M Ceballos
- School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
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Edwards TA, Thompson HS, Kwate NOA, Brown K, McGovern MM, Forman A, Kapil-Pair N, Jandorf L, Bovbjerg DH, Valdimarsdottir HB. Association between temporal orientation and attitudes about BRCA1/2 testing among women of African descent with family histories of breast cancer. PATIENT EDUCATION AND COUNSELING 2008; 72:276-282. [PMID: 18479882 PMCID: PMC2703430 DOI: 10.1016/j.pec.2008.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 03/14/2008] [Accepted: 03/23/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Previous studies have identified specific attitudes (pros and cons) about BRCA testing held by women of African descent that are associated with decisions to participate in testing. These testing attitudes may be determined, in part, by temporal orientation, or how one perceives the significance of events and the consequences of their actions in terms of past, present, and future. The current study explored the relationship between temporal orientation and pros and cons of BRCA testing among 140 women of African descent with a family history suggestive of a genetic mutation predisposing to breast cancer. METHODS Participants completed measures of temporal orientation and genetic testing attitudes. RESULTS Multivariate analyses indicated that future orientation was positively associated with perceived pros of testing. Additional analyses revealed significant associations between temporal orientation and specific item subsets related to the negative and positive impact of testing on family and personal control over one's health. CONCLUSION These results support an association between temporal orientation and attitudes about BRCA testing among women of African descent with family histories of breast cancer. PRACTICE IMPLICATIONS Findings support exploration of temporal orientation in future research on BRCA testing decisions among women of African descent and this construct's importance in developing decision aids and tailoring genetic counseling.
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Kessler L, Domchek S, Stopfer J, Halbert CH. BRCA1 and BRCA2 risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer. ACTA ACUST UNITED AC 2008; 11:193-200. [PMID: 18417966 DOI: 10.1159/000116879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe BRCA1 or BRCA2 (BRCA1/2) risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer and to identify factors having independent associations with these perceptions. METHODS Risk perceptions were evaluated by self-report during a structured telephone interview among African American women (n = 162) at increased risk for hereditary cancer who were recruited from oncology clinics, general medical practices, and community oncology resources. RESULTS The majority of women (75%) believed that it was likely that they had a BRCA1/2 mutation. Women ages 50 and younger and those with greater cancer-specific worry were most likely to believe that they had a BRCA1/2 mutation. CONCLUSIONS Although BRCA1/2 risk perceptions may be consistent with objective risk levels among African American women, discussion about the basis of risk perceptions may enhance provision of genetic counseling and testing in this population.
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Affiliation(s)
- Lisa Kessler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Patterson AR, Davis H, Shelby K, McCoy J, Robinson LD, Rao SK, Banerji P, Tomlinson GE. Successful strategies for increasing African American participation in cancer genetic studies: hopeful signs for equalizing the benefits of genetic medicine. ACTA ACUST UNITED AC 2008; 11:208-14. [PMID: 18417968 DOI: 10.1159/000116881] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether prior success in recruiting African Americans to an in-house cancer genetics registry could be duplicated when recruiting to a national registry requiring a significantly increased level of commitment. Additionally, to determine which recruitment sources and practices yielded the highest number of African American participants. METHODS A retrospective analysis of recruitment sources, practices, and results for recruitment to the Cancer Genetics Network (CGN; a national research registry), from 2000 to 2005 was conducted. These results were compared to previous experience in recruiting African Americans to the Family Cancer Registry (FCR; an in-house registry) during the period 1992-2005. RESULTS In the 1st year of recruitment to the CGN, African Americans accounted for 24% of those consenting to participate in the CGN registry from our center. This compares to an average annual rate of 27% for the FCR during the years 1998-2005, and a rate of less than 1% from 1992 to 1998. By 2005, African Americans accounted for 27% of CGN participants recruited through the University of Texas Southwestern Medical Center, one of eighteen participating institutions in the CGN. Hospital-based resources such as cancer treatment clinics and tumor registries yielded the highest percentage of African American participants (66.5%), and self-referral yielded the lowest (0%). Seventy-seven percent of African Americans were actively sought out and recruited from treatment clinics, whereas the vast majority of Caucasian participants were recruited passively during the course of genetic counseling sessions that were scheduled for reasons unrelated to participation in cancer research. There were no known instances of African Americans contacting CGN staff after reading printed recruitment materials or internet advertisements. CONCLUSIONS The increased level of commitment required of CGN participants did not deter African Americans from participating in cancer genetics research. Recruitment strategies responsible for dramatically increasing recruitment rates to the FCR from 1998 to 2000 were equally effective when used for recruitment to the CGN. The most effective recruitment sources were high-yield venues such as cancer treatment clinics and tumor registries, and active recruitment methods yielded the highest number of African American participants. Advertising through internet announcements and printed recruitment materials did not appear to be effective.
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Affiliation(s)
- Annette R Patterson
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Tex., USA
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Susswein LR, Skrzynia C, Lange LA, Booker JK, Graham ML, Evans JP. Increased Uptake of BRCA1/2 Genetic Testing Among African American Women With a Recent Diagnosis of Breast Cancer. J Clin Oncol 2008; 26:32-6. [DOI: 10.1200/jco.2007.10.6377] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Studies suggest that African American women are less likely to pursue BRCA1/2 genetic testing than white women. However, such studies are often confounded by unequal access to care. Methods Data from 132 African American and 636 white women, obtained from a clinical database at the University of North Carolina (Chapel Hill, NC) between 1998 and 2005, were analyzed to assess BRCA1/2 genetic testing uptake. Importantly, the clinical setting minimized barriers of both cost and access. Race and time of new breast cancer diagnosis (recent v > 1 year before genetic evaluation) were assessed for association with BRCA1/2 testing uptake using multivariable logistic regression models. Results Both race (P = .0082) and a recent diagnosis of breast cancer (P = .014) were independently associated with testing uptake. African American women had a lower estimated odds of pursuing testing than white women (odds ratio [OR], 0.54; 95%CI, 0.34 to 0.85), and women with a recent diagnosis had a higher OR than those with a remote diagnosis (OR, 1.58; 95% CI, 1.10 to 2.29). In a race-stratified analysis, there was no statistical evidence for association between recent status and testing uptake in the larger white stratum (OR, 1.38, P = .13) while there was for the smaller African American sample (OR, 2.77, P = .018). The test of interaction between race and remote status was not significant (P = .15). Conclusion African American race was associated with an overall decreased uptake of BRCA1/2 genetic testing, even when barriers of ascertainment and cost were minimized. However, among African American women, a recent diagnosis of breast cancer was associated with substantially increased uptake of testing.
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Affiliation(s)
- Lisa R. Susswein
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
| | - Cécile Skrzynia
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
| | - Leslie A. Lange
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
| | - Jessica K. Booker
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
| | - Mark L. Graham
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
| | - James P. Evans
- From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC
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Assessing hypothetical scenario methodology in genetic susceptibility testing analog studies: a quantitative review. Genet Med 2007; 9:727-38. [PMID: 18007141 PMCID: PMC9942866 DOI: 10.1097/gim.0b013e318159a344] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hypothetical scenario methodology is commonly employed in the study of genetic susceptibility testing uptake estimation. The methodology, however, has not been rigorously assessed and sizeable gaps exist between estimated and actual uptake for tests that have recently become available. This quantitative review explores the effect of several theoretically based factors on genetic test uptake accuracy among a sample of 38 articles. These factors include verbal immediacy and temporal proximity of test scenarios, method of decision assessment, content of testing detail provided, processing demand required, and study features related to administration and sample. A number of assessed factors influenced uptake accuracy. Among these, temporal proximity of the genetic susceptibility test appeared to be the most consistent. There was also some evidence for effects of verbal immediacy and decision-assessment method on interest in testing. We recommend strategies for increasing accuracy using hypothetical scenario methodology to examine genetic susceptibility test uptake prediction.
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