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Culver JO, Bertsch NL, Kurz RN, Cheng LL, Pritzlaff M, Rao SK, Stasi SM, Stave CD, Sharaf RN. Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling. Genet Med 2024; 26:100980. [PMID: 37688462 DOI: 10.1016/j.gim.2023.100980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Genetic counseling (GC) is standard of care in genetic cancer risk assessment (GCRA). A rigorous assessment of the data reported from published studies is crucial to ensure the evidence-based implementation of GC. METHODS We conducted a systematic review and meta-analysis of 17 patient-reported and health-services-related outcomes associated with pre- and post-test GC in GCRA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Twenty-five of 5393 screened articles met inclusion criteria. No articles reporting post-test GC outcomes met inclusion criteria. For patient-reported outcomes, pre-test GC significantly decreased worry, increased knowledge, and decreased perceived risk but did not significantly affect patient anxiety, depression, decisional conflict, satisfaction, or intent to pursue genetic testing. For health-services outcomes, pre-test GC increased correct genetic test ordering, reduced inappropriate services, increased spousal support for genetic testing, and expedited care delivery but did not consistently improve cancer prevention behaviors nor lead to accurate risk assessment. The GRADE certainty in the evidence was very low or low. No included studies elucidated GC effect on mortality, cascade testing, cost-effectiveness, care coordination, shared decision making, or patient time burden. CONCLUSION The true impact of GC on relevant outcomes is not known low quality or absent evidence. Although a meta-analysis found that pre-test GC had beneficial effects on knowledge, worry, and risk perception, the certainty of this evidence was low according to GRADE methodology. Further studies are needed to support the evidence-based application of GC in GCRA.
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Affiliation(s)
- Julie O Culver
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| | | | - Raluca N Kurz
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Linda L Cheng
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | | | | | | | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine and Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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2
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Tamayo LI, Perez F, Perez A, Hernandez M, Martinez A, Huang X, Zavala VA, Ziv E, Neuhausen SL, Carvajal-Carmona LG, Duron Y, Fejerman L. Cancer screening and breast cancer family history in Spanish-speaking Hispanic/Latina women in California. Front Oncol 2022; 12:940162. [PMID: 36387260 PMCID: PMC9643826 DOI: 10.3389/fonc.2022.940162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background Breast cancer is the most common cancer among women in the U.S. and the leading cause of cancer death among Hispanics/Latinas (H/L). H/L are less likely than Non-H/L White (NHW) women to be diagnosed in the early stages of this disease. Approximately 5-10% of breast cancer can be attributed to inherited genetic mutations in high penetrance genes such as BRCA1/2. Women with pathogenic variants in these genes have a 40-80% lifetime risk of breast cancer. Past studies have shown that genetic counseling can help women and their families make informed decisions about genetic testing and early cancer detection or risk-reduction strategies. However, H/L are 3.9-4.8 times less likely to undergo genetic testing than NHW women. We developed a program to outreach and educate the H/L community about hereditary breast cancer, targeting monolingual Spanish-speaking individuals in California. Through this program, we have assessed cancer screening behavior and identified women who might benefit from genetic counseling in a population that is usually excluded from cancer research and care. Materials and Methods The "Tu Historia Cuenta" program is a promotores-based virtual outreach and education program including the cities of San Francisco, Sacramento, and Los Angeles. Participants responded to three surveys: a demographic survey, a breast cancer family history survey, and a feedback survey. Survey responses were described for participants and compared by area where the program took place using chi-square, Fisher exact tests, and t tests. Multinomial logistic regression models were used for multivariate analyses. Results and Conclusion We enrolled 1042 women, 892 completed the cancer family history survey and 62 (7%) provided responses compatible with referral to genetic counseling. We identified 272 women (42.8% ages 40 to 74 years) who were due for mammograms, 250 women (24.7% ages 25 to 65 years) due for Papanicolaou test, and 189 women (71.6% ages 50+) due for colorectal cancer screening. These results highlight the need of additional support for programs that spread awareness about cancer risk and facilitate access to resources, specifically within the H/L community.
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Affiliation(s)
- Lizeth I. Tamayo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Fabian Perez
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Angelica Perez
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | | | | | - Xiaosong Huang
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Valentina A. Zavala
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Elad Ziv
- Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Luis G. Carvajal-Carmona
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, CA, United States,Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
| | - Ysabel Duron
- The Latino Cancer Institute, San Jose, CA, United States
| | - Laura Fejerman
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States,Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States,*Correspondence: Laura Fejerman,
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3
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Wehbe A, Manning M, Assad H, Purrington KS, Simon MS. Uptake of genetic counseling and testing in a clinic-based population of women with breast cancer. Cancer Med 2022; 11:3304-3311. [PMID: 35322585 PMCID: PMC9468430 DOI: 10.1002/cam4.4684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background The study was conducted to evaluate racial differences in referral and uptake of genetic counseling (GC) in a clinic‐based population of women with breast cancer. Methods Medical records of 150 breast cancer patients at the Karmanos Cancer Institute were reviewed to determine eligibility for GC according to National Comprehensive Cancer Network guidelines, GC referral rates, and appointment completion rates. Logistic regression was used to assess the relationship between demographic and clinical factors and GC eligibility and referral. Results The mean age at diagnosis was 57.1 (SD 12.6) and 66% of the women were Black. There were 91 women (60.7%) eligible for GC and of those, 54 (61.4%) were referred. After multivariable analyses, factors associated with reduced eligibility were older age at diagnosis (OR = 0.91, 95% CI [0.87,0.95]) and Black race (OR = 0.37, 95% CI [0.15, 0.96]). After additional multivariable analysis, eligibility was associated with an increased likelihood of referral (OR = 5.97, 95% CI [2.29, 15.56]), however, Medicare versus private insurance was associated with a lower likelihood for referral (OR = 0.32, 95% CI [0.12–0.80]. Of those referred, 49 (76.6%) completed an appointment, and 47 had genetic testing. Women with Medicare were also less likely to complete an appointment. Race had no impact on referral or appointment completion. Conclusions There were no racial differences in GC referral or appointment completion in a clinic‐based sample of women with breast cancer. Further interventions are needed to promote increased referral and appointment completion for women with breast cancer who are eligible for GC.
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Affiliation(s)
- Alexandra Wehbe
- Wayne State University School of Medicine, Detroit, Michigan, USA.,Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Mark Manning
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.,Department of Psychology, Oakland University, Rochester Hills, Michigan, USA
| | - Hadeel Assad
- Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Kristen S Purrington
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michael S Simon
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.,Department of Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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4
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Reid S, Spalluto LB, Lang K, Weidner A, Pal T. An overview of genetic services delivery for hereditary breast cancer. Breast Cancer Res Treat 2022; 191:491-500. [PMID: 35079980 PMCID: PMC8789372 DOI: 10.1007/s10549-021-06478-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women worldwide, with approximately 5-10% of cases attributed to high penetrance hereditary breast cancer (HBC) genes. The tremendous advances in precision oncology have broadened indications for germline genetic testing to guide both systemic and surgical treatment, with increasing demand for cancer genetic services. The HBC continuum of care includes (1) identification, access, and uptake of genetic counseling and testing; (2) the delivery of genetic counseling and testing services; and (3) initiation of guideline-adherent follow-up care and family communication of results. Challenges to delivering care on the HBC care continuum include factors such as access to services, cost, discrimination and bias, and lack of education and awareness, which can be mitigated through implementing a multi-level approach. This includes strategies such as increasing awareness and utilization of genetic counseling and testing, developing new methods to meet the growing demand for genetic services, and improving the uptake of follow-up care by increasing patient and provider awareness of the management recommendations.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA.
| | - Lucy B Spalluto
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, USA
| | - Katie Lang
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Weidner
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tuya Pal
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA.
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 1500 21st Avenue South. Suite 2810, Nashville, TN, 37212, USA.
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5
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Almeida R, Lopez-Macha A, Dugatkin T, Joseph G, Duron Y, Hurtado de Mendoza A, D. Graves K, Fejerman L. Community research collaboration to develop a promotores-based hereditary breast cancer education program for Spanish-speaking Latinas. HEALTH EDUCATION RESEARCH 2021; 36:319-336. [PMID: 34113985 PMCID: PMC9115327 DOI: 10.1093/her/cyab011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Breast cancer (BC) is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed at later stages, receive poorer quality care and have a higher risk of mortality than non-Latina White (NLW) women. Among women with a genetic predisposition to hereditary BC, genetic counseling can be beneficial. Latinas participate in genetic counseling at lower rates than NLW women. The goal of this study was to develop comprehensive, culturally appropriate materials for community health educators (promotores)-led hereditary BC education program for Spanish-speaking Latinas. We developed the curriculum through feedback from 7 focus groups, with a total of 68 participants (35 promotores and 33 community members). We used a mixed-methods approach that relied on quantitative analysis of survey questions and qualitative content analysis of the focus groups transcripts. Pre and post promotores' training survey responses suggested improvement in the promotores' cancer-related knowledge. Themes that emerged from the qualitative analyses were (i) barriers to health education and/or care; (ii) importance of educating the Latino community about BC and genetics and (iii) role of the promotores. Future research will further evaluate the impact of the program in promotores' knowledge and community members' screening behaviors.
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Affiliation(s)
| | | | | | - Galen Joseph
- University of California, San Francisco, CA, USA
| | | | | | | | - Laura Fejerman
- University of California, San Francisco, CA, USA
- University of California, Davis, San Francisco, CA, USA
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6
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Reid S, Cadiz S, Pal T. Disparities in Genetic Testing and Care among Black women with Hereditary Breast Cancer. CURRENT BREAST CANCER REPORTS 2020; 12:125-131. [PMID: 33603954 PMCID: PMC7885902 DOI: 10.1007/s12609-020-00364-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Despite a steady improvement in breast cancer survival rates over the past several decades, mortality disparities remain among Black women, who have a 42% higher death rate compared to non-Hispanic white (NHW) women. Hereditary breast cancer (HBC) accounts for 5-10% of all breast cancer cases, the majority of which are due to the BRCA1 and BRCA2 (BRCA) genes. Despite the availability of BRCA testing for over 25 years, there remain disproportionately lower rates of genetic testing among Blacks compared to NHW due to a multitude of factors. The intent of this review is to discuss racial disparities focused on HBC across diverse populations and review the existing gaps to be addressed when delivering gene-based care. RECENT FINDINGS The factors contributing to the racial survival disparity are undoubtedly complex and likely an interplay between tumor biology, genomics, patterns of care and socioeconomic factors. Advances in genomic technologies that now allow for full characterization of germline DNA sequencing are integral in defining the complex and multifactorial cause of breast cancer and may help to explain the existing racial survival disparities. SUMMARY Identification of inherited cancer risk may lead to cancer prevention, early cancer detection, treatment guidance, and ultimately has great potential to improve outcomes. Consequently, advances in HBC diagnosis and treatment without widespread implementation have the potential to further widen the existing breast cancer mortality gap between Black and NHW women.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, TN
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7
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Cragun D, Weidner A, Tezak A, Zuniga B, Wiesner GL, Pal T. A Web-Based Tool to Automate Portions of Pretest Genetic Counseling for Inherited Cancer. J Natl Compr Canc Netw 2020; 18:841-847. [PMID: 32634774 DOI: 10.6004/jnccn.2020.7546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing demand for genetic testing for inherited cancer risk coupled with a shortage of providers trained in genetics highlight the potential for automated tools embedded in the clinic process to meet this demand. We developed and tested a scalable, easy-to-use, 12-minute web-based educational tool that included standard pretest genetic counseling elements related to panel-based testing for multiple genes associated with cancer risk. METHODS The tool was viewed by new patients at the Vanderbilt Hereditary Cancer Clinic before meeting with a board-certified genetics professional. Pre- and post-tool surveys measured knowledge, feeling informed/empowered to decide about testing, attitudinal values about genetic testing, and health literacy. Of the initial 100 participants, 50 were randomized to only have knowledge measured on the post-tool survey to assess for a priming effect. RESULTS Of 360 patients approached, 305 consented and completed both the pre- and post-tool surveys, with a mean age of 47 years, including 80% female patients and 48% patients with cancer. Survey results showed an increase in knowledge and feeling informed/empowered after viewing the tool (P<.001), but no significant change in attitude (P=.64). Post-tool survey data indicated no difference in median knowledge between low and high health literacy groups (P=.30). No priming effect was present among the initial 100 participants (P=.675). CONCLUSIONS Viewing the educational tool resulted in significant gains in knowledge across health literacy levels, and most individuals felt informed and empowered to decide about genetic testing. These findings indicate that the use of an automated pretest genetic counseling tool may help streamline the delivery of genetic services.
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Affiliation(s)
- Deborah Cragun
- 1College of Public Health, University of South Florida, Tampa, Florida; and
| | - Anne Weidner
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Ann Tezak
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Brenda Zuniga
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Georgia L Wiesner
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and.,3Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Tuya Pal
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and.,3Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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8
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Pal T, Radford C, Weidner A, Tezak AL, Cragun D, Wiesner GL. The Inherited Cancer Registry (ICARE) Initiative: An Academic-Community Partnership for Patients and Providers. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10463356.2018.1525993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tuya Pal
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Cristi Radford
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Anne Weidner
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Ann Louise Tezak
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Deborah Cragun
- University of South Florida, College of Public Health, Tampa, Fla
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9
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Cragun D, Weidner A, Lewis C, Bonner D, Kim J, Vadaparampil ST, Pal T. Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer 2017; 123:2497-2505. [PMID: 28182268 PMCID: PMC5474124 DOI: 10.1002/cncr.30621] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast cancer (BC) disparities may widen with genomic advances. The authors compared non-Hispanic white (NHW), black, and Hispanic BC survivors for 1) cancer risk-management practices among BRCA carriers and 2) provider discussion and receipt of genetic testing. METHODS A population-based sample of NHW, black, and Hispanic women who had been diagnosed with invasive BC at age 50 years or younger from 2009 to 2012 were recruited through the state cancer registry. Multiple logistic regression was used to compare cancer risk-management practices in BRCA carriers and associations of demographic and clinical variables with provider discussion and receipt of testing. RESULTS Of 1622 participants, 159 of 440 (36.1%) black women, 579 of 897 (64.5%) NHW women, 58 of 117 (49.6%) Spanish-speaking Hispanic women, and 116 of 168 (69%) English-speaking Hispanic women underwent BRCA testing, of whom 90 had a pathogenic BRCA mutation identified. Among BRCA carriers, the rates of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy were significantly lower among black women compared with Hispanic and NHW women after controlling for clinical and demographic variables (P = .025 and P = .008, respectively). Compared with NHW women, discussion of genetic testing with a provider was 16 times less likely among black women (P < .0001) and nearly 2 times less likely among Spanish-speaking Hispanic women (P = .04) after controlling for clinical and sociodemographic factors. CONCLUSIONS The current results suggest that the rates of risk-reducing salpingo-oophorectomy are lower among black BRCA carriers compared with their Hispanic and NHW counterparts, which is concerning because benefits from genetic testing arise from cancer risk-management practice options. Furthermore, lower BRCA testing rates among blacks may partially be because of a lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities. Cancer 2017;123:2497-05. © 2017 American Cancer Society.
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Affiliation(s)
- Deborah Cragun
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
- Department of Global Health, College of Public Health, University of South Florida
| | - Anne Weidner
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
| | - Courtney Lewis
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
| | - Devon Bonner
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
| | - Jongphil Kim
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
| | | | - Tuya Pal
- Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
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10
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Cragun D, Weidner A, Lewis C, Bonner D, Kim J, Vadaparampil ST, Pal T. Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer 2017. [PMID: 28182268 DOI: 10.1002/cncr.30621.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breast cancer (BC) disparities may widen with genomic advances. The authors compared non-Hispanic white (NHW), black, and Hispanic BC survivors for 1) cancer risk-management practices among BRCA carriers and 2) provider discussion and receipt of genetic testing. METHODS A population-based sample of NHW, black, and Hispanic women who had been diagnosed with invasive BC at age 50 years or younger from 2009 to 2012 were recruited through the state cancer registry. Multiple logistic regression was used to compare cancer risk-management practices in BRCA carriers and associations of demographic and clinical variables with provider discussion and receipt of testing. RESULTS Of 1622 participants, 159 of 440 (36.1%) black women, 579 of 897 (64.5%) NHW women, 58 of 117 (49.6%) Spanish-speaking Hispanic women, and 116 of 168 (69%) English-speaking Hispanic women underwent BRCA testing, of whom 90 had a pathogenic BRCA mutation identified. Among BRCA carriers, the rates of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy were significantly lower among black women compared with Hispanic and NHW women after controlling for clinical and demographic variables (P = .025 and P = .008, respectively). Compared with NHW women, discussion of genetic testing with a provider was 16 times less likely among black women (P < .0001) and nearly 2 times less likely among Spanish-speaking Hispanic women (P = .04) after controlling for clinical and sociodemographic factors. CONCLUSIONS The current results suggest that the rates of risk-reducing salpingo-oophorectomy are lower among black BRCA carriers compared with their Hispanic and NHW counterparts, which is concerning because benefits from genetic testing arise from cancer risk-management practice options. Furthermore, lower BRCA testing rates among blacks may partially be because of a lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities. Cancer 2017;123:2497-05. © 2017 American Cancer Society.
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Affiliation(s)
- Deborah Cragun
- Population Sciences, Moffitt Cancer Center, Tampa, Florida.,Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Anne Weidner
- Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Courtney Lewis
- Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Devon Bonner
- Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Jongphil Kim
- Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | | | - Tuya Pal
- Population Sciences, Moffitt Cancer Center, Tampa, Florida
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11
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Frey MK, Pothuri B. Homologous recombination deficiency (HRD) testing in ovarian cancer clinical practice: a review of the literature. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:4. [PMID: 28250960 PMCID: PMC5322589 DOI: 10.1186/s40661-017-0039-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/07/2017] [Indexed: 01/07/2023]
Abstract
Until recently our knowledge of a genetic contribution to ovarian cancer focused almost exclusively on mutations in the BRCA1/2 genes. However, through germline and tumor sequencing an understanding of the larger phenomenon of homologous recombination deficiency (HRD) has emerged. HRD impairs normal DNA damage repair which results in loss or duplication of chromosomal regions, termed genomic loss of heterozygosity (LOH). The list of inherited mutations associated with ovarian cancer continues to grow with the literature currently suggesting that up to one in four cases will have germline mutations, the majority of which result in HRD. Furthermore, an additional 5-7% of ovarian cancer cases will have somatic HRD. In the near future, patients with germline or somatic HRD will likely be candidates for a growing list of targeted therapies in addition to poly (ADP-ribose) polymerase (PARP) inhibitors, and, as a result, establishing an infrastructure for widespread HRD testing is imperative. The objective of this review article is to focus on the current germline and somatic contributors to ovarian cancer and the state of both germline and somatic HRD testing. For now, germline and somatic tumor testing provide important and non-overlapping clinical information. We will explore a proposed testing strategy using somatic tumor testing as an initial triage whereby those patients found with somatic testing to have HRD gene mutations are referred to genetics to determine if the mutation is germline. This strategy allows for rapid access to genomic information that can guide targeted treatment decisions and reduce the burden on genetic counselors, an often limited resource, who will only see patients with a positive somatic triage test.
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Affiliation(s)
- Melissa K Frey
- Division of Gynecologic Oncology, Weill Cornell Medicine, 525 East 68th Street, Suite J-130, New York, NY 10065 USA
| | - Bhavana Pothuri
- Division of Gynecologic Oncology, New York University Langone Medical Center, 240 E. 38th St, 19th floor, New York, NY 10016 USA
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12
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Buchanan AH, Voils CI, Schildkraut JM, Fine C, Horick NK, Marcom PK, Wiggins K, Skinner CS. Adherence to Recommended Risk Management among Unaffected Women with a BRCA Mutation. J Genet Couns 2016; 26:79-92. [PMID: 27265406 DOI: 10.1007/s10897-016-9981-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/24/2016] [Indexed: 01/01/2023]
Abstract
Identifying unaffected women with a BRCA mutation can have a significant individual and population health impact on morbidity and mortality if these women adhere to guidelines for managing cancer risk. But, little is known about whether such women are adherent to current guidelines. We conducted telephone surveys of 97 unaffected BRCA mutation carriers who had genetic counseling at least one year prior to the survey to assess adherence to current guidelines, factors associated with adherence, and common reasons for performing and not performing recommended risk management. More than half of participants reported being adherent with current risk management recommendations for breast cancer (69 %, n = 67), ovarian cancer (82 %, n = 74) and both cancers (66 %, n = 64). Older age (OR = 10.53, p = 0.001), white race (OR = 8.93, p = 0.019), higher breast cancer genetics knowledge (OR = 1.67, p = 0.030), higher cancer-specific distress (OR = 1.07, p = 0.002) and higher physical functioning (OR = 1.09, p = 0.009) were significantly associated with adherence to recommended risk management for both cancers. Responses to open-ended questions about reasons for performing and not performing risk management behaviors indicated that participants recognized the clinical utility of these behaviors. Younger individuals and those with lower physical functioning may require targeted interventions to improve adherence, perhaps in the setting of long-term follow-up at a multi-disciplinary hereditary cancer clinic.
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Affiliation(s)
- Adam H Buchanan
- Geisinger Health System, Genomic Medicine Institute, M.C. 26-20, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Catherine Fine
- Department of Genetics, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Nora K Horick
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - P Kelly Marcom
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Kristi Wiggins
- Division of Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Celette Sugg Skinner
- Department of Clinical Sciences and Harold C Simmons Cancer Center, University of Texas - Southwestern, Dallas, TX, USA
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13
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Buchanan AH, Rahm AK, Williams JL. Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review. Front Oncol 2016; 6:120. [PMID: 27242960 PMCID: PMC4865495 DOI: 10.3389/fonc.2016.00120] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Abstract
Demand for cancer genetic counseling has grown rapidly in recent years as germline genomic information has become increasingly incorporated into cancer care, and the field has entered the public consciousness through high-profile celebrity publications. Increased demand and existing variability in the availability of trained cancer genetics clinicians place a priority on developing and evaluating alternate service delivery models for genetic counseling. This mini-review summarizes the state of science regarding service delivery models, such as telephone counseling, telegenetics, and group counseling. Research on comparative effectiveness of these models in traditional individual, in-person genetic counseling has been promising for improving access to care in a manner acceptable to patients. Yet, it has not fully evaluated the short- and long-term patient- and system-level outcomes that will help answer the question of whether these models achieve the same beneficial psychosocial and behavioral outcomes as traditional cancer genetic counseling. We propose a research agenda focused on comparative effectiveness of available service delivery models and how to match models to patients and practice settings. Only through this rigorous research can clinicians and systems find the optimal balance of clinical quality, ready and secure access to care, and financial sustainability. Such research will be integral to achieving the promise of genomic medicine in oncology.
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Affiliation(s)
| | | | - Janet L. Williams
- Geisinger Health System, Genomic Medicine Institute, Danville, PA, USA
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Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance. J Genet Couns 2015; 24:961-70. [PMID: 25833335 DOI: 10.1007/s10897-015-9836-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (n = 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were $106 per telegenetics patient and $244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantly more likely to attend CGC than telegenetics patients (89 vs. 79 %, p = 0.03), with bivariate analyses showing an association between lesser computer comfort and lower attendance rate (Chi-square = 5.49, p = 0.02). Our randomized trial of telegenetics vs. in-person counseling found that telegenetics cost less than in-person counseling, with high satisfaction among those who attended. This study provides support for future randomized trials comparing multiple service delivery models on longer-term psychosocial and behavioral outcomes.
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Kwong A, Chu ATW, Wu CTS, Tse DMS. Attitudes and compliance of clinical management after genetic testing for hereditary breast and ovarian cancer among high-risk Southern Chinese females with breast cancer history. Fam Cancer 2014; 13:423-30. [PMID: 24623488 DOI: 10.1007/s10689-014-9706-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Western studies have shown that the uptake rates of surveillance and prophylaxis may vary among BRCA mutation carriers between ethnicities. The present study is the first to investigate the behavioural impact and subjective attitudes in Southern Chinese high-risk families who had undergone BRCA1 and BRCA2 genetic testing up to 2.5 years post-testing. Individuals who had such genetic testing and have consented to participate in the prospective database of Hong Kong Hereditary Breast Cancer Family Registry were recruited and surveyed by a face-to-face or telephone interview. Sociodemographic information, genetic test results, pre- and post-testing surveillance, medical regimes, and attitudes towards the choice of clinical management were obtained by interviews and retrieval of medical records using this prospective database. 69 females with breast cancer history were recruited into the study. Twenty-nine female carriers (15 BRCA1 mutated gene-carriers and 14 BRCA2 mutated gene-carriers) and 40 non-carriers of a BRCA 1/2 mutations were interviewed. The uptake rate of high risk breast screening i.e. clinical breast examination, mammography, and breast MRI is significantly higher among female carriers (48.3 %) after knowing genetic testing results than before (p < 0.01). A strong significant relationship between any increase or decrease of ovarian ultrasound screening (OS) and genetic status is found (p < .001), with more females did OS and with a higher frequency after knowing genetic testing results among both carriers (22.7 % → 86.4 %) and non-carriers (37.5 % → 50.0 %). Among carriers, very few opted for prophylactic surgeries. The present cohort might see prophylaxis as last resort and would use traditional Chinese medicine in cancer risk management.
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Affiliation(s)
- Ava Kwong
- Division of Breast Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China,
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16
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Use of a Patient-Entered Family Health History Tool with Decision Support in Primary Care: Impact of Identification of Increased Risk Patients on Genetic Counseling Attendance. J Genet Couns 2014; 24:179-88. [DOI: 10.1007/s10897-014-9753-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/29/2014] [Indexed: 12/19/2022]
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17
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Cragun D, Pal T. Identification, Evaluation, and Treatment of Patients with Hereditary Cancer Risk within the United States. ISRN ONCOLOGY 2013; 2013:260847. [PMID: 24455306 PMCID: PMC3884954 DOI: 10.1155/2013/260847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/19/2013] [Indexed: 02/06/2023]
Abstract
Recognizing the importance of identifying patients at high risk for inherited cancer predisposition, the United States Preventive Services Task Force (USPSTF) has outlined specific family history patterns associated with an increased risk for BRCA mutations. However, national data indicate a need to facilitate the ability of primary care providers to appropriately identify high risk patients. Once a patient is identified as high risk, it is necessary for the patient to undergo a detailed genetics evaluation to generate a differential diagnosis, determine a cost-effective genetic testing strategy, and interpret results of testing. With identification of inherited predisposition, risk management strategies in line with national guidelines can be implemented to improve patient outcomes through cancer risk reduction and early detection. As use of genetic testing increasingly impacts patient outcomes, the role of primary care providers in the identification and care of individuals at high risk for hereditary cancer becomes even more important. Nevertheless it should be acknowledged that primary care providers face many competing demands and challenges to identify high risk patients. Therefore initiatives which promote multidisciplinary and coordinated care, potentially through academic-community partnerships, may provide an opportunity to enhance care of these patients.
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Affiliation(s)
- Deborah Cragun
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Tuya Pal
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Pal T, Vadaparampil ST. Genetic risk assessments in individuals at high risk for inherited breast cancer in the breast oncology care setting. Cancer Control 2013; 19:255-66. [PMID: 23037493 DOI: 10.1177/107327481201900402] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It has become increasingly common to consider BRCA mutation status when determining optimal cancer risk management and treatment options in order to improve patient outcomes. Knowledge about the risk for hereditary cancer at or as close as possible to the time of diagnosis allows patients access to the most risk reduction options available. METHODS This paper illustrates the role of genetic risk assessment for hereditary breast cancer, using hereditary breast and ovarian cancer (HBOC) syndrome as a model due to germline mutations in the BRCA1 and BRCA2. Specifically, the value of genetic counseling and testing for HBOC across the cancer prevention and control continuum is outlined as it pertains to breast cancer. RESULTS In recognition of the importance of risk assessment for hereditary breast cancer, leading health professional organizations have developed specific guidelines and recommendations to providers for identification of women at increased risk for carrying a BRCA mutation. CONCLUSIONS Institutional efforts specific to genetic counseling and testing have resulted in the implementation of a model driven by physician recommendation as a referral system for high-risk breast cancer patients. Establishing an infrastructure to support research, education, and outreach initiatives focused on BRCA genetic counseling and testing will provide information that can improve the delivery of cancer genetics services.
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Affiliation(s)
- Tuya Pal
- Population Sciences Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Dutil J, Colon-Colon JL, Matta JL, Sutphen R, Echenique M. Identification of the prevalent BRCA1 and BRCA2 mutations in the female population of Puerto Rico. Cancer Genet 2012; 205:242-8. [PMID: 22682623 DOI: 10.1016/j.cancergen.2012.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 03/15/2012] [Accepted: 04/04/2012] [Indexed: 01/07/2023]
Abstract
Mutations in the breast cancer 1, early onset (BRCA1) and breast cancer 2 (BRCA2) genes are responsible for the majority of hereditary breast cancers. Knowledge of the incidence and prevalence of BRCA mutations in a specific population or ethnic group is necessary to provide accurate genetic counseling for breast cancer patients and their families; however, these data have not been gathered in the population of Puerto Rico. We conducted a retrospective study of female breast cancer patients undergoing genetic testing for BRCA mutations in the highest-volume breast surgery practices in San Juan, Puerto Rico. Data collection includes three-generation family cancer history and results from complete BRCA sequencing. A total of six different deleterious mutations were observed, including one mutation in BRCA1 and five mutations in BRCA2. Three recurrent mutations (BRCA1 del exon1-2, BRCA2 4150G>T, and BRCA2 6027del4) account for over 70% of all the BRCA mutations observed in this study population. This study examines for the first time the characteristics of hereditary breast cancer in Puerto Rico and assesses the accuracy of existing genetic risk assessment tools in that population. This data is expected to contribute to providing accurate and efficient tools for the clinical management of hereditary breast cancer in Puerto Rico.
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Affiliation(s)
- Julie Dutil
- Department of Biochemistry, Ponce School of Medicine, Puerto Rico.
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21
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Von Wachenfeldt A, Brandberg Y, Johansson H, Fornander T. Socioeconomic status and quality of life of women with family history of breast cancer attending an oncogenetic counseling clinic: a comparison with general population. Acta Oncol 2009; 48:86-92. [PMID: 18759137 DOI: 10.1080/02841860802343182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Women with high risk for breast cancer due to family history are offered genetic counseling and surveillance. The aim of this cross-sectional study was to characterize women at an oncogenetic counseling clinic in terms of socioeconomic status (SES) and health related quality of life (HRQOL) and to compare data with population based figures. MATERIAL AND METHODS All healthy women who had ever visited the Oncogenetic clinic, Department of Oncology, Sodersjukhuset, 1998-2004 were eligible. A total of 306 women consented to participate (82.5%). SES data were compared with official data for all women (n=277,783), in the same age, living in the same geographical area at the time the study was performed. HRQOL data (SF-36) were compared with Swedish normative data. RESULTS Significantly more women in the study group were cohabiting (74.2 vs. 43.8%), had the highest education level, (56.7 vs. 39.6%) and had the highest household income (36.9 vs. 12.9%) as compared to the reference population in the same catchment area. Study subjects report significant lower levels of HRQOL for subscales related to mental health and for general health compared to normative data, but similar levels on HRQOL subscales related to physical health. DISCUSSION Attendees at the oncogenetic clinic appears to have higher socioeconomic status and lower quality of life as compared to women living in the same area, although the genetic predisposition for breast cancer is considered to be evenly distributed in the population. Thus, efforts to reach women in lower socioeconomic groups should be elaborated.
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Tolerance for ambiguity could influence awareness of breast cancer genetic testing and inform health education. Cancer Causes Control 2008; 19:1227-32. [DOI: 10.1007/s10552-008-9193-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 06/11/2008] [Indexed: 10/21/2022]
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23
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Bennett P, Wilkinson C, Turner J, Griffith G, France B, Brain K, Gray J. The impact of breast cancer genetic risk assessment on intentions to perform cancer surveillance behaviors. J Genet Couns 2007; 16:617-23. [PMID: 17549613 DOI: 10.1007/s10897-007-9100-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
One hundred and fifty-four women undergoing breast/ovarian cancer genetic risk assessment completed questionnaires at entry into the Cancer Genetic Service for Wales (CGSW) assessment program and following risk provision, mapping the strength of intentions to engage in a number of preventive/surveillance behaviors, including seeing specialists, breast self-examination, and involvement in screening programs, including mammography. A number of potential predictors of intentions were also assessed, including participants' mood and emotional response to receiving risk information, the perceived benefits (in terms of reassurance and early disease detection) of engaging in each preventive behavior, and the perceived desires of their family and General Practitioner. Intentions to self-examine did not change following risk provision, although strength of intentions to engage in some other preventive behaviors did lessen. Family and General Practitioners appeared to be strong social influences on behavioral intentions, as were the perceived benefits of gaining reassurance and/or early detection of disease.
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Affiliation(s)
- Paul Bennett
- Centre for Nursing, Health and Social Research, University of Cardiff, Cardiff CF24 0AB, UK.
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24
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Bjorvatn C, Eide GE, Hanestad BR, Øyen N, Havik OE, Carlsson A, Berglund G. Risk perception, worry and satisfaction related to genetic counseling for hereditary cancer. J Genet Couns 2007; 16:211-22. [PMID: 17279329 DOI: 10.1007/s10897-006-9061-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients' worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients' and counselors' scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients' perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients' psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.
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Affiliation(s)
- Cathrine Bjorvatn
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Helmes AW, Culver JO, Bowen DJ. Results of a randomized study of telephone versus in-person breast cancer risk counseling. PATIENT EDUCATION AND COUNSELING 2006; 64:96-103. [PMID: 16427245 DOI: 10.1016/j.pec.2005.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 11/23/2005] [Accepted: 12/02/2005] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk. Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing. This study measured the effects of an intervention in-person and by telephone, compared to a control group. METHODS Participants were 340 women, recruited through a network of primary care physicians. They received a baseline questionnaire in the mail, were randomized to one of the three study arms, and completed a follow-up survey 3 months later. RESULTS Both types of counseling were very well received. The counseling decreased women's cancer worry, risk perceptions, and intentions to pursue genetic testing. There were similar effects for both in-person and telephone counseling. CONCLUSION Genetic counseling can be used to inform women at all risk levels about their breast cancer risk. PRACTICE IMPLICATIONS Breast cancer risk counseling can be done in-person and by telephone--thereby reaching women in remote areas.
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Affiliation(s)
- Almut W Helmes
- Institute of Psychology, Department of Rehabilitation Psychology, University of Freiburg, 79085 Freiburg, Germany.
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Mosher CE, Danoff-Burg S, Brunker B. Post-traumatic growth and psychosocial adjustment of daughters of breast cancer survivors. Oncol Nurs Forum 2006; 33:543-51. [PMID: 16676011 DOI: 10.1188/06.onf.543-551] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine post-traumatic growth, or positive life changes, and its correlates among adult daughters of breast cancer survivors and to compare their psychosocial adjustment to women with healthy parents. DESIGN Descriptive, cross-sectional survey. SETTING Outpatient oncology units in two urban hospitals and two breast cancer organizations. SAMPLE 30 adult daughters of breast cancer survivors (mean age = 38.1 years) and 16 women with healthy parents. METHODS Participants were recruited by hospital or research staff or responded to an announcement in a newsletter. Respondents completed the Post-Traumatic Growth Inventory and standardized assessments of psychosocial adjustment. MAIN RESEARCH VARIABLES Post-traumatic growth and demographic, stressor, and psychosocial variables. FINDINGS Women who cared for their mothers following breast cancer diagnosis and perceived their mothers' illness to be stressful reported greater post-traumatic growth. Life satisfaction, social support, emotional processing strategies, and problem-focused coping strategies also were positively associated with growth. Women with maternal histories of breast cancer and those with healthy parents did not differ in psychosocial well-being, including affect, life satisfaction, and social support. CONCLUSIONS Findings suggest that some daughters of breast cancer survivors experience positive life changes following their mothers' illness. IMPLICATIONS FOR NURSING For nurses seeking to adopt a holistic approach to practice, the personal growth of women following life-threatening familial illness warrants attention.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, State University of New York, Albany, NY, USA.
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