Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: a systematic review

Genetic counseling referral rates and genetic testing outcomes in women with young breast cancer: a 20-year Canadian review

PURPOSE

Despite guidelines recommending genetic testing for all cases of very young breast cancer (VYBC), poor uptake has been reported. This study aimed to examine genetic testing referral rates and outcomes over a 20-year period within the Canadian context.

METHODS

A retrospective chart review of all incident VYBC cases (at or below 35 years of age) between January 1, 2000 and December 31, 2019 was conducted. Descriptive statistics were used to summarize demographic factors and logistic regression analyses were performed to identify the predictors associated with referral for genetic counseling and positive genetic test results.

RESULTS

628 women were identified with VYBC. Most women presented with stage 2 (42%), hormone receptor-positive (HR +) and HER2-negative (54%) invasive ductal carcinoma (94%). Over the study period, referral rates increased from 44 to 84%. Of women initially tested for BRCA1/BRCA2, only 21% were referred for updated panel testing. Among those tested, 19% had a pathogenic variant, 21% of whom reported no family history of cancer. Predictors of referral included stage 0-2 disease while predictors of positive test results included a second breast cancer diagnosis and positive family history.

CONCLUSION

Despite guidelines based on age alone, barriers to referral persist. Results of this study suggest the need for new models of care that ensure equitable access to genetic testing for all women diagnosed with VYBC regardless of family history, ethnicity, or disease stage. As genetic testing criteria evolve, protocols must address these barriers to prevent missed opportunities for testing.

Awareness and utilization of genetic testing for hereditary cancers in cancer survivors: a cross-sectional 2021 HINTS-SEER study

PURPOSE

We aimed to identify factors associated with genetic testing awareness and use among a large sample of US cancer survivors participating in NCI's Health Information National Trends Survey of cancer survivors identified through the Surveillance, Epidemiology, and End Results program, a unique pilot study expanding the number of cancer survivors typically captured by HINTS.

METHODS

We analyzed 2021 HINTS-SEER data to determine sociodemographic factors associated with awareness and utilization of germline genetic testing using survey-weight-adjusted multivariable logistic regression.

RESULTS

Of 1232 survivors (any site), the majority had breast (23%) or prostate (23%) cancer. Among the overall study population, 77% were aware of and 24% utilized genetic testing. Females and those with a college education, income over $100,000, or family history of cancer had greater odds of awareness compared to males, those with less than college education, income under $20,000, or no family history, respectively. Among prostate cancer survivors, those ≥ 65 years in age had lower odds of awareness. Females and the privately insured had greater odds of utilization compared to males and publicly insured, respectively. Those ≥ 65 years or retired had lower odds of utilization compared to < 65 years and being employed, respectively.

CONCLUSION

We identified sociodemographic factors associated with awareness and utilization of germline genetic testing among cancer survivors. Findings warrant further investigation to understand mechanisms underlying disparities in awareness and use of genetic testing.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights cancer survivor populations that may require additional support around awareness of and use of germline genetic testing.

Germline testing for prostate cancer: current state and opportunities for enhanced access

Germline Testing (GT) for prostate cancer (PCA) is now central to PCA care and hereditary cancer assessment, with a rising role in PCA screening approaches. Guidelines have significantly expanded to include testing patients with metastatic PCA, advanced PCA or with high-risk features, and for males with or without PCA with a strong family cancer history to identify hereditary cancer syndromes for patients and their families. However, the expansion of GT has overwhelmed genetic counselling programs, necessitating the development and evaluation of alternate genetic delivery models. Furthermore, disparities in engagement in PCA GT are of major concern for impacting PCA-related and overall cancer-related outcomes for patients and their families. This review focuses on integrating PCA GT guidelines with implementation strategies and addressing PCA GT disparities to help inform current and future strategies to enhance the benefits of GT across populations.

A Mixed-Methods Approach to Assessing Barriers and Facilitators to Cancer Genetics Care in Black and Latino/a Individuals Impacted by Pancreatic Cancer: The Racial/ethnic Equity in GENetic Education, Risk Assessment, and TEsting (REGENERATE) Study

PURPOSE

Pancreatic ductal adenocarcinoma (PDAC) disproportionately impacts Black and Latino/a communities, who are less likely to receive genetic counseling/testing referrals, hindering early cancer detection/prevention access. This study aims to determine the barriers/facilitators to PDAC genetics care/surveillance among Black and Latino/a populations.

METHODS

This is a concurrent mixed-methods study that utilized electronic surveys and semi-structured focus groups/in-depth interviews (02/14/2022-12/21/2022). This was a volunteer sample of Black or Latino/a general participants with a personal or family history of PDAC and community leaders serving these groups. Participants discussed barriers/facilitators to PDAC cancer genetics care/surveillance. Health literacy, cancer worry, medical trust, and inherited cancer risk were assessed using electronic surveys. Discussions were recorded, transcribed, and analyzed using a content analysis approach. Chi-square tests, two-sample t-tests, and one-way analysis of variance were used to evaluate survey data using R v4.3.2.

RESULTS

55 participants (n = 27 general participants, 28 leaders) completed surveys. 27 (49%) self-identified as Black and 23 (42%) as Latino/a. Leaders (74%) reported higher levels of perceived medical mistrust among their communities than general participants (Trust in Physician Scale mean/SD 29.9/4.2 vs. 38.4/5.2, p < 0.001; Medical Mistrust Index = 18.8/4.2 vs. 24.4/3.6; p < 0.001, respectively). General participants self-reported higher digital health seeking capabilities than leaders' perception of that skillset (p < 0.001). 24 of these participants completed a focus group/in-depth interview, emphasizing informed discussions with a trusted/established provider.

CONCLUSIONS

Individuals impacted by PDAC are open to genetics care and desire resources to promote PDAC surveillance. It is also crucial that leaders and providers be engaged to facilitate access to this care.

Nonadherence to guidelines for genetic testing in families with ovarian cancer shows racial bias

PURPOSE

The National Comprehensive Cancer Network (NCCN) recommends germline genetic testing for individuals at risk for hereditary ovarian cancer. We sought to determine the proportion and characteristics of individuals meeting testing criteria in a multicenter biobank who were appropriately offered testing.

METHODS

In this retrospective cohort study, we identified Mass General Brigham Biobank participants meeting genetic testing criteria per NCCN guidelines. Logistic regression was used to analyze sociodemographic factors associated with which participants were offered testing, completed testing, and had a family history that matched their self-report documented in the electronic medical record.

RESULTS

Most eligible participants (909/1441, 63.1%) were not offered genetic testing. Participants who were Black or Hispanic had a lower likelihood of being offered testing. Compared with self-report, 988 (68.6%) participants had a family history of ovarian cancer documented in their electronic medical record. Older age, Hispanic ethnicity, and public insurance use were associated with decreased likelihoods of accurate family history documentation. Correct documentation was associated with an increased likelihood of being offered testing.

CONCLUSION

The majority of participants in this study did not receive NCCN-compliant care. Germline genetic testing for hereditary ovarian cancer screening is underutilized and access to this testing is currently inequitable.

"Es Lindo, Pero Estamos Perdidos"-Characterizing Facilitators and Barriers to Clinical Genetic Testing for Latino Populations

As genetic testing in clinical settings has been increasingly implemented, Latino populations are not benefiting at the same rates. Although many Latino individuals express a strong interest to use genetic testing, significant disparities exist with uptake. This study used semi-structured qualitative elicitation interviews to identify relevant referents (network of family/friends), socio-environmental facilitators, and barriers to genetic testing for a Latino-only cohort. The interviews explored attitudes toward genetic testing; beliefs about genetic testing, social norms, and control over ability to have genetic testing; and confidence in ability to test while probing upon perceived barriers and facilitators. Interviews were conducted with 19 self-identifying Latino individuals older than 18 years of age who spoke English or Spanish, stratified by previous testing or none. Respondents had overwhelmingly positive attitudes towards genetic testing. Many noted they simply did not understand the purpose of testing, what results could mean, and what results could be used for. Further, related to this limited knowledge, many noted their primary care providers seldom mention genetic testing. Finally, language preferences seem to be a critical barrier, as all those who have tested reported receiving services in English. Despite positive attitudes, strong referent networks, and strong interest towards genetic testing uptake for respondents, many also mentioned they had no idea how to test. More outreach is needed to educate Latino groups, and their providers, about genetic testing, while creating more systemic facilitators in genetic testing service delivery to encourage testing uptake.

Facilitators and Barriers to Uptake of Genetic and Cascade Testing in Familial Hypercholesterolemia: a Systematic Review

BACKGROUND

Familial hypercholesterolemia (FH) is an underdiagnosed autosomal dominant genetic disorder that confers high but preventable risk for premature adverse cardiovascular events. Timely diagnosis is limited by low uptake of genetic testing (GT) and cascade testing (CT). This systematic review identifies barriers and facilitators for uptake of GT and CT in FH.

METHOD

Following PRISMA guidelines, seven databases were searched for studies on GT/CT in FH. Data reporting standards for qualitative studies were evaluated with COREQ and thematic synthesis was conducted. Of the 387 studies identified, 15 were included (qualitative N = 9, quantitative N = 6). These involved 272,954 respondents (qualitative n = 243, quantitative n = 272,711). COREQ scores ranged from 11 to 21 out of 32.

RESULTS

Synthesis of qualitative data indicated family history of illness, being well informed, and value of GT as key facilitators of GT. Financial concerns, suboptimal clinical care, and no/low value of GT were identified as barriers. Facilitators of CT included responsibility to family, healthcare providers' support for CT, and gains of CT, while barriers included disconnect from family, emotional costs, and no value knowing FH status. Quantitative studies reflect emotional distress avoidance, limited opportunity for family disclosure to invite, lack of knowledge, low communication efficacy, and difficulties accessing testing services as predictors impacting CT.

CONCLUSION

Beyond knowledge, perceptions about testing-especially perceived value of testing-emerged to be significantly affecting decisions for GT/CT. Disconnect from family is a maior predictor in CT, reducing the likelihood of probands extending an invitation to their family in support of CT. Future interventions should address barriers and facilitators at interpersonal, clinical and systemic levels to improve FH GT/CT uptake. Additionally, further research in diverse cultural contexts is required to bridge gaps in GT/CT services. Interventions should especially prioritize risk perception education and the development of health communication tools to supplement strong clinical guidance, driving a more patient-centered approach in decisions relating to GT/CT.

Association of Social Determinants of Health With Genetic Test Request and Completion Rates in Children With Neurologic Disorders

BACKGROUND AND OBJECTIVES

Genetic testing is critical for optimal diagnosis and management of pediatric neurology patients, but access is challenging. We investigated whether social determinants of health (SDOH) were associated with genetic testing among pediatric neurology patients in a retrospective observational study.

METHODS

Electronic health record data were extracted from pediatric outpatients (0-18 years) evaluated at a single tertiary care institution between July 2018 and January 2020. Genetic testing requests, insurance denials, and test completion rates were compared among non-Hispanic single-racial or multiracial Black (Black) vs non-Hispanic single-racial White (White) patients. SDOH and clinical variables including ethnoracial identity, insurance type, Area Deprivation Index, rural urban commuting area, sex, age, diagnoses, and number of neurology visits were evaluated to identify associations with chromosomal microarray (CMA), multigene panel (MGP), and exome/genome sequencing (ES/GS) test completion.

RESULTS

Of 11,371 patients (mean age 9.25 years; 46.1% female), 554 (4.9%) completed ≥1 genetic test in the study interval, with White patients nearly twice as likely to have completed ≥1 genetic test compared with Black patients (aOR 1.88, 95% CI 1.41-2.51). Outpatient pediatric neurology was the most common specialty through which testing was completed. Neurology provider request rates for genetic testing did not differ by patient ethnoracial identity, but insurance denial rates after neurology request were lower for White vs Black patients (relative rate ratio [RR] 0.44, 95% CI 0.27-0.73), and those with public insurance were less likely to complete genetic testing after it was requested through neurology (aOR 0.59, 95% CI 0.35-0.97). However, when considering individual genetic test types completed through any specialty, insurance type was significantly associated only with MGP completion (public vs private OR 0.56, 95% CI 0.40-0.77), not CMA or ES/GS.

DISCUSSION

Marked ethnoracial disparities in genetic testing completion were identified despite equivalent rates of genetic testing requests by neurologists. While Black patients had higher rates of insurance denials, insurance type itself accounted for the disparity in MGP but not CMA or ES/GS completion. Other unmeasured barriers stemming from systemic racism likely affected genetic testing among Black patients.

Information Avoidance: Past Perspectives and Future Directions

In the present age of unprecedented access to information, it is important to understand how and why people avoid information. Multiple definitions of "information avoidance" exist, and key aspects of these definitions deserve attention, such as distinguishing information avoidance from (lack of) information seeking, considering the intentionality and temporal nature of information avoidance, and considering the personal relevance of the information. In this review, we provide a cross-disciplinary historical account of theories and empirical research on information avoidance and seeking, drawing from research in multiple fields. We provide a framework of antecedents of information avoidance, categorized into beliefs about the information (e.g., risk perceptions), beliefs about oneself (e.g., coping resources), and social and situational factors (e.g., social norms), noting that constructs across categories overlap and are intertwined. We suggest that research is needed on both positive and negative consequences of information avoidance and on interventions to reduce information avoidance (when appropriate). Research is also needed to better understand temporal dynamics of information avoidance and how it manifests in everyday life. Finally, comprehensive theoretical models are needed that differentiate avoidance from seeking. Research on information avoidance is quickly expanding, and the topic will only grow in importance.

Preferences for genetic testing among populations underrepresented in genomic research: a systematic review

Equitable implementation of genomic medicine requires understanding preferences of diverse populations. Stated preference methods, such as discrete choice experiments (DCEs) and conjoint analyses, allow empirical evaluation of whether and how preferences for aspects of genomic medicine tests and services differ according to demographic characteristics. We aimed to understand the extent to which stated preference research in genomic medicine includes respondents that are population representative and evidence regarding preference heterogeneity by race and ethnicity. We conducted a systematic review of the stated preference literature in genomic medicine. We searched Web of Science, CINAHL, PsycINFO, PubMed, Embase, Cochrane Library, and SCOPUS for articles published from February 2021 to November 2023, extending a previously published systematic review. We extracted information on whether demographic characteristics of respondents were reported, whether investigators tested for preference heterogeneity based on race and ethnicity, and whether preference heterogeneity by race and ethnicity was identified. We identified 138 newly published records in addition to the 38 articles included in the original review. In total, we included 18 articles that reported participants' race or ethnicity. Eight articles explicitly analyzed preferences by race and ethnicity, and preference heterogeneity was identified in two. Stated preference research in genomic medicine often does not include population representative samples, and preference heterogeneity is not frequently analyzed according to race and ethnicity. Improving the representativeness of respondent populations, which allows for better understanding of whether and how preferences may differ by population subgroups, is important to guide policy and implementation decisions in genomic medicine.

Prevalence and Predictors of Medical Mistrust Among Socioeconomically and Racially Diverse Cancer Patients in Philadelphia

Background/Objectives: Medical mistrust (MM) is associated with adverse health outcomes, but few studies have assessed MM in cancer patients. MM is frequently measured using the Medical Mistrust Inventory (MMI), measuring institutional MM (e.g., government), or the Group-Based Medical Mistrust Scale (GBMMS), measuring race-based MM. We sought to assess the prevalence of MM among cancer patients diverse by age, sex, race/ethnicity, and socioeconomic status (SES), recruited from an urban safety net hospital and a suburban comprehensive cancer center. Methods: Patients completed a one-time survey. The primary outcome was MM as measured by the GBMMS and MMI tools. Covariates included demographics, treatment campus (urban vs. suburban), and psychosocial measures relevant to MM. Results: Purposeful sampling recruitment resulted in 200 participants (survey completion: 74.6%). The median age was 60 years, with 62% female, 45% African-American, 15% Hispanic, 47.5% education ≤ HS diploma, and 51.5% income ≤ USD 50,000/yr. Elevated MMI and GBMMS scores (moderate-to-high) were seen, respectively, in Hispanic (20.7% and 33.4%) and African-American (AA) patients (31.8% and 48.9%), compared with White patients (14.3% and 9.9%). The MMI and GBMMS tools captured complimentary aspects of MM in cancer patients (Spearman's 0.531, p < 0.0001). MMI was associated with lower education (0.034) and race (p = 0.04), while GBMMS was strongly associated with race (p < 0.001), urban campus (p = 0.035), and mistrust of government/health organization information (both p < 0.05). Higher MMI/GBMMS scores were both associated with research mistrust and mistrust of information from physicians. Conclusions: Institutional and race-based MM are prevalent among cancer patients diverse by age, sex, race/ethnicity, and SES. Lower education was associated with institutional MM but not race-based MM.

Investigating knowledge and attitudes toward genetic testing and counseling among palestinians

Genetic testing is important in the diagnosis of genetic disorders. Genetic counseling integrates the interpretation of the results of genetic testing to reach informed decisions concerning genetic disorders. Palestine has an increased incidence of genetic disorders primarily due to the continued practice of consanguineous marriage. Nevertheless, limited research has been conducted to explore public awareness regarding genetic testing and genetic counseling. The current study aimed to assess the public knowledge, attitudes, and practices of Palestinians toward genetic testing and genetic counseling. A cross-sectional study was performed using an online questionnaire that gathered information from Palestinians whose ages were 18 years or older between April and July 2024. The questionnaire gathered demographic information about the participants and assessed their genetic test usage patterns and their knowledge, practices, and attitudes toward genetic testing and counseling. A total of 1056 participants (408 males and 648 females) completed the questionnaire. The mean age of participants was 31.18 years. Sixty-seven point 6% of the participants reported their knowledge about the term genetic testing; however, only 35.5% of them knew the term genetic counseling. Knowledge of genetic testing was significantly associated with younger ages, higher levels of education, and higher income (p < 0.05). Knowledge of genetic counseling was significantly associated with higher income and was more familiar among married participants and those who underwent routine check-ups. Only 9% indicated that they underwent genetic testing which was higher among older ages, married participants, among those undergoing routine check-ups, and among participants who had hereditary disorders in their families. Among the 95 participants who had genetic tests, 52.6% of them performed it for marriage. Other reasons for undergoing genetic testing were diagnosis (22.1%), followed by carrier testing (17.9%), and predictive and pre-symptomatic testing (10.5%). Sixty-point-6% of respondents reported they would like to perform genetic testing as a predictive test for cancer risk. Participants with higher levels of education were more likely to perform cancer-predictive genetic testing (p < 0.05). Participants who were undergoing routine check-ups, those who had reported their health status as poor, and those who had hereditary disorders in their families were more likely to perform predictive cancer genetic testing. In conclusion, there is insufficient knowledge about genetic counseling among Palestinians. Despite the relatively good knowledge of genetic testing, this has not translated into appropriate practice. Genetic testing is still not widely practiced and the most common for performing it is pre-marriage testing rather than medical reasons. It is strongly recommended to increase awareness about genetic testing and genetic counseling among Palestinians. In particular, these programs should be directed toward people with lower levels of education, and toward families with a high degree of consanguinity and consequently a high incidence of genetic disorders.

Disparities in Genetic Testing for Inborn Errors of Immunity

BACKGROUND

Inequities in genetic testing have been documented in a range of diseases, and no-charge genetic testing programs have been proposed as a means to enhance access. However, no studies have examined disparities in genetic testing for inborn errors of immunity (IEI) and the impact of no-charge programs on testing equity.

OBJECTIVE

To examine socioeconomic, geographic, and racial disparities in the uptake of genetic testing for IEI in the United States and the impact of a no-charge sponsored program on testing equity.

METHODS

This was a retrospective cohort analysis of (1) a national claims database capturing individuals with IEI (n = 18,603), and (2) data from a clinical genetic testing laboratory capturing patients with IEI participating in a no-charge sponsored program (n = 6,681) and a non-sponsored program (n = 29,579) for IEI genetic testing.

RESULTS

Among patients with IEI captured in the claims database, those residing in areas of greater deprivation (odds ratio [OR] = 0.95; 95% CI, 0.92-0.98), rural areas (OR = 0.82; 95% CI, 0.71-0.96), and non-White neighborhoods (OR = 0.89, 95% CI 0.81-0.98) were less likely to undergo genetic testing. Participants in the sponsored IEI genetic testing program lived in areas of greater deprivation compared with the non-sponsored program (median, 46 vs 42; P < .001). However, historically excluded racial groups were underrepresented in both the sponsored and non-sponsored programs relative to disease burden.

CONCLUSIONS

We found significant disparities in genetic testing for IEI. Although eliminating the financial barriers to testing reduced socioeconomic disparities in genetic testing for IEI, racial disparities persisted. Further research is needed to address barriers to testing among underserved populations.

Exploring the Role of Communication Asset Mapping (CAM) as a Strategy to Promote Hereditary Cancer Risk Assessment Information Within African American Communities

Objective: African Americans (AAs) carry the largest burden for almost every type of cancer in the US and are also more likely to die from cancer. Approximately 10% of cancers can be explained by a hereditary factor and detected earlier. Many AAs, however, have inequitable access to hereditary cancer risk assessment (HCRA) tools and information, further exacerbating disparities in cancer rates. Innovative communication strategies to promote community-based HCRA information have promise as a means encouraging optimal primary cancer screening among AAs. The current pilot study followed a participatory process where researchers engaged with a Community Advisory Board (CAB) to explore how Communication Asset Mapping (CAM) could assist lay health advisors with the dissemination of evidence-based HC/RA information within AA faith communities. Methods: The research team and CAB conducted exploratory community-engaged group discussions with residents (n = 21) guided by Communication Infrastructure Theory, and used a community-engaged mapping process to inform the development of a CAM dissemination strategy. Results: Through textual analysis, the following conclusions were reached: (1) optimal locations (e.g., community centers) within specified neighborhood networks should have representatives who are trusted ambassadors to assist with HCRA information dissemination; (2) trusted community member voices should fully represent the neighborhood network in the community-engagement mapping process; (3) well-known and frequented geographic locations should provide a true representation of participants' neighborhoods to create a robust health information network concerning HCRA. Conclusions: Community residents appreciated the engagement process; however, they felt that its impact was limited due to the lack of community voices within their neighborhoods to identify important communication resources within the network for optimal HCRA information dissemination. CAM, therefore, is an important public health strategy for the identification of trusted networks and useful communication resources within these networks. The strategy was also helpful in pinpointing people who could be critical communicators of emerging health information akin to HCRA.

Neighborhood Disadvantage and Genetic Testing Use Among a Nationally Representative Sample of US Adults

INTRODUCTION

Genetic testing helps individuals with disease management, family planning, and medical decision-making. Identifying individual-level factors related to the use of genetic services is essential but may only partially explain differential genetic service usage. To address this knowledge gap, we analyzed data on a national sample of US adults to evaluate whether higher neighborhood vulnerability is significantly associated with lower genetic testing utilization, controlling for sociodemographic and health characteristics.

METHODS

A 2024 nationally representative cross-sectional survey of 631 US adults recruited using NORC's probability-based AmeriSpeak panel. Genetic testing uptake was measured as self-reported ever use of ancestry, personal trait, specific disease, or prenatal genetic carrier testing. Secondary outcomes were indicator variables for each genetic testing type. Neighborhood vulnerability (low versus high) was measured by the Social Vulnerability Index, capturing socioeconomic factors affecting community resilience to natural hazards and disasters.

RESULTS

Forty-eight percent of the weighted sample used genetic testing services. Compared to those in low vulnerability areas, individuals in high vulnerability areas had 42% lower odds (adjusted OR: 0.58, 95% CI: 0.37-0.90) of using genetic testing services, controlling for individual-level characteristics. Secondary analyses showed no evidence of statistically significant relationships between neighborhood vulnerability and specific types of genetic testing services.

CONCLUSION

Findings suggest that neighborhood vulnerability may contribute to differences in genetic testing uptake, which is crucial to increasing early detection of cancer susceptibility and reducing US cancer incidence. This study demonstrates the importance of going beyond examining individual characteristics to investigating structural factors negatively impacting genetic testing usage.

Disparities in Hereditary Genetic Testing in Patients with Triple Negative Breast Cancer

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer that disproportionately affects younger females, non-Hispanic Black women, Hispanic women, and women with the BRCA1 gene mutation. Hereditary genetic testing is particularly important in this population to assess preventative and treatment strategies, however access to genetic testing is variable. A qualitative review was performed to evaluate barriers to genetic testing for patients with TNBC. Mutations common in breast cancer are reviewed along with updated guidelines on management strategies, including the ability to include PARP inhibitors as a treatment strategy. Barriers to genetic testing are multifactorial, with non-Hispanic Black women being tested less often than other groups. The disparity is even further represented by the limited number of non-Hispanic Black patients with TNBC who receive risk-reducing surgery or targeted systemic therapy. Eliminating barriers to genetic testing can allow us to support guideline-directed care for patients with TNBC at higher risk for genetic mutations.

Perspectives of people with cystic fibrosis considering parenthood surrounding preconception and prenatal genetic counseling and testing

BACKGROUND

People with cystic fibrosis (pwCF) are increasingly considering their reproductive options. Currently, there are many genetic testing options available for pwCF and their reproductive partners. Healthcare providers, including genetic counselors, can educate pwCF about these options and support them through the decision-making process.

OBJECTIVE

This study explored the role of genetics in the reproductive decisions of pwCF and their perspectives and experiences surrounding prenatal and preconception genetic counseling and testing.

DESIGN

We conducted a qualitative study of a national US sample of pwCF age ⩾18 years recruited from the CF Foundation Community Voice platform.

METHODS

We conducted and recorded semi-structured telephone interviews with participants. We utilized Dedoose software and applied inductive thematic analysis to code the interview transcripts and elicit themes.

RESULTS

We interviewed 21 participants (76.2% women, 95.2% White, 4.8% Hispanic, 57.1% parents, 23.8% considering parenthood). Key themes included: (1) pwCF appeared to understand the genetics of CF and were typically first introduced to CF genetics by CF providers, school, or their parents; (2) pwCF had diverse perspectives on having a child with CF; (3) carrier testing was an important consideration for some participants when making decisions about biological parenthood; (4) participants understood the role of genetic counselors and valued their knowledge, but only half previously met with a genetic counselor; (5) pwCF believed genetics information should be presented during childhood/adolescence and reinforced when interested in family planning.

CONCLUSION

pwCF have discrepant views on passing on CF to future offspring, and although there is recognition of the role of genetic counseling and a desire for knowledge from genetic testing, genetic considerations are but one factor involved in parenthood decisions. Future work should develop patient-, provider-, or system-based interventions to best integrate high-quality genetics and genetic counseling care into the CF team for those with CF considering parenthood.

Effect of communicating genetic risk of type 2 diabetes and wearable technologies on wearable device-measured behavioural outcomes in East Asians: protocol of a randomised controlled trial

INTRODUCTION

The communication of information about the risk of type 2 diabetes (T2D) alone has not been associated with changes in habitual behaviours among individuals of European ancestry. In contrast, the use of wearable devices that monitor physical activity (PA) has been associated with behavioural changes in some studies. It is uncertain whether risk communication might enhance the effects of wearable devices. We aim to assess the effects of communicating genetic risk for T2D alone or in combination with wearable device functions on wearable device-measured PA among overweight or obese East Asians.

METHODS AND ANALYSIS

In a parallel group, randomised controlled trial, 355 overweight or obese East Asian individuals aged 40-60 years are allocated into one of three groups: one control and two intervention groups. Blood samples will be used for estimation of T2D genetic risk and analysis of metabolic risk markers. Genetic risk of T2D will be estimated based on 113 single-nucleotide polymorphisms associated with T2D among East Asians. All three groups receive a Fitbit device. Both intervention groups will receive T2D genetic risk estimates along with lifestyle advice, but one of the intervention groups additionally uses Fitbit's step goal setting and prompt functions. Questionnaires and physical measurements are administered at baseline, immediately after intervention delivery, and 6 and 12 months post intervention. The primary outcome is time spent in moderate-to-vigorous PA from the Fitbit, which will be assessed at baseline, immediately post intervention, 12 months post intervention and at 6-month follow-up. Secondary outcomes include other wearable device-measured parameters, sedentary time, and sleep, blood pressure, metabolic risk markers, hand grip strength, self-reported PA, fruit and vegetable consumption, smoking, and psychological variables. Between-group differences in the continuous and categorical variables collected at baseline will be examined using Analysis of Variance (ANOVA) and χ2 tests, respectively. A series of linear mixed effects models with fixed effects of time, group and interaction between time and group will be performed, with adjustment for potential confounders.

ETHICS AND DISSEMINATION

The study protocol has undergone review and received approval from the ethics committee of the University of Hong Kong. Findings from our trial will be disseminated through publication in peer-reviewed research journals and presented at international academic conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT05524909. https://register.

CLINICALTRIALS

gov/ (11 November 2024).

Contextualizing Race and Ethnicity in the Practice of Laboratory Medicine

Race and ethnicity are population descriptors that clinicians and researchers often use to classify humans. The utility of these groupings in research and clinical contexts warrants scrutiny, since these groupings fail to adequately capture genetic diversity and instead, are proxies for the complex interplay of genetic, social, and structural determinants of health. Here, the authors review the concepts of race, ethnicity, and genetics. They also describe laboratory medicine examples where race and ethnicity are used that warrant scrutiny and revision, and areas where greater emphasis on including racialized minorities is necessary to improve health disparities.

Assessing Bias Toward a Black or White Simulated Patient with Obesity in a Virtual Reality-Based Genomics Encounter

Interpersonal bias based on weight and race is widespread in the clinical setting; it is crucial to investigate how emerging genomics technologies will interact with and influence such biases in the future. The current study uses a virtual reality (VR) simulation to investigate the influence of apparent patient race and provision of genomic information on medical students' implicit and explicit bias toward a virtual patient with obesity. Eighty-four third- and fourth-year medical students (64% female, 42% White) were randomized to interact with a simulated virtual patient who appeared as Black versus White, and to receive genomic risk information for the patient versus a control report. We assessed biased behavior during the simulated encounter and self-reported attitudes toward the virtual patient. Medical student participants tended to express more negative attitudes toward the White virtual patient than the Black virtual patient (both of whom had obesity) when genomic information was absent from the encounter. When genomic risk information was provided, this more often mitigated bias for the White virtual patient, whereas negative attitudes and bias against the Black virtual patient either remained consistent or increased. These patterns underscore the complexity of intersectional identities in clinical settings. Provision of genomic risk information was enough of a contextual shift to alter attitudes and behavior. This research leverages VR simulation to provide an early look at how emerging genomic technologies may differentially influence bias and stereotyping in clinical encounters.

Cancer genetic counseling in Chile: Addressing barriers, confronting challenges, and seizing opportunities in an underserved Latin American Community

Purpose

Despite the rapid advancements in genomics and the enactment of a new cancer law in Chile, the implementation of cancer genetic counseling continues to face significant challenges because of limited resources and infrastructure.

Methods

We conducted a survey targeting health care providers who offer genetic counseling to patients with cancer and possess training in genetics and counseling. Additionally, we distributed a separate survey to high-risk patients associated with an advocacy group to gather insights on their perceptions of and experiences with cancer genetic counseling.

Results

Among the surveyed providers, 21% were nonmedical professionals who developed their skills through postgraduate continuing education programs. Germline testing was not performed in 47% of cases. Among the participants, 37% considered genetic counseling important for understanding the cause of their cancer, 25% valued knowing their risk of developing future tumors, and 33% believed it would benefit their current cancer treatment. Just over half of the patients (54%) had access to genetic counseling. Among those that received genetic counseling, 85% found it beneficial.

Conclusion

In Chile, barriers to genetic counseling persist, particularly in rural areas and because of a shortage of trained professionals. Public policies recognizing genetic counseling's importance are crucial, along with expanding training and infrastructure. Understanding patient perceptions and increasing the number of trained genetic counseling into cancer care, educating clinicians, and advocating for increased access are key steps for enhancing cancer treatment effectiveness in Chile.

What Do Breast Cancer Previvors Tell Us About Their Stories? To Know or Not to Know?

OBJECTIVES

This study aimed to explore the (1) experiences of breast cancer previvor women during genetic testing; (2) perceptions of the impact of genetic testing on their personal, social, family, and professional lives; and (3) views on breast cancer prevention and follow-up processes. This study focused on the risk of breast cancer in persons with BRCA mutations.

METHODS

Data were collected through individual in-depth semistructured interviews. The data were analyzed using the MAXQDA program based on the method suggested by Graneheim and Lundman.

RESULTS

This study was conducted in Istanbul, Turkey, and included 17 participants. Five themes emerged from the data analysis-Acquaintance with BRCA, Living with BRCA, Managing the Legacy, Maternalism, and We Are Here, including a total of 12 categories.

CONCLUSION

The previvors had negative experiences during genetic testing, mainly owing to a lack of information, stigma, and women's roles in society. A structured and individualized process for genetic counseling was identified as the main requirement.

IMPLICATIONS FOR NURSING PRACTICE

National and international policies on breast cancer previvors should be developed to prevent breast cancer and reduce mortality. Adopting a multidisciplinary approach during genetic counseling will favorably contribute to previvors' medical and psychosocial well-being. Follow-up programs before and after genetic testing should be created. Society's cultural and genetic literacy levels should be evaluated, and activities should be planned to raise social awareness.

Raising awareness and education of genetic testing and counseling through fotonovelas among Latina women at risk for hereditary breast and ovarian cancer

Latinas are less likely to receive genetic counseling and genetic testing (GCT) compared to non-Latina Whites because of systemic and patient-level barriers. We developed and tested fotonovelas to increase awareness of GCT among Latinas at-risk of hereditary breast and ovarian cancer (HBOC). Content for the fotonovelas was drawn from an existing culturally targeted narrative video focused on improving GCT use among Latinas at-risk of HBOC. Using mixed methods, we interviewed cancer patients (n = 10) and their relatives (n = 10) to assess the preliminary efficacy of the fotonovelas through pre-and post-fotonovela items assessing self-rated knowledge of GCT and willingness to discuss cancer with family. Health workers (n = 10) provided feedback on the fotonovela content. McNemar's test was used to examine differences in the proportions of the outcomes pre- and post-fotonovelas. Interviews were transcribed and coded in Dedoose using a consensual qualitative research approach. Reading the fotonovelas increased self-rated knowledge of GCT by 22% (p = 0.16), from 50 to 60% in patients and from 63 to 100% among relatives. Analogously, reading the fotonovela increased willingness to talk about cancer with family by 33% (p = 0.02), from 70 to 100% in patients and from 38 to 75% in relatives. We identified six themes, some centered around the fotonovela's message, feedback, and perceived barriers to GCT. Overall, participants liked the use of fotonovelas to increase GCT awareness and cancer conversations with family. Fotonovelas could potentially be used as educational tools to increase GCT awareness and cancer conversations among Latino families at-risk of HBOC.

Adaptation of the socioecological model to address disparities in engagement of Black men in prostate cancer genetic testing

BACKGROUND

Black men consistently have higher rates of prostate cancer (PCA)- related mortality. Advances in PCA treatment, screening, and hereditary cancer assessment center around germline testing (GT). Of concern is the significant under-engagement of Black males in PCA GT, limiting the benefit of precision therapy and tailored cancer screening despite longstanding awareness of these disparities. To address these critical disparities, the Socioecological Model (SEM) was employed to develop comprehensive recommendations to overcome barriers and implement equitable strategies to engage Black males in PCA GT.

METHODS

Clinical/research experts, national organization leaders, and community stakeholders spanning multiple regions in US and Africa participated in developing a framework for equity in PCA GT grounded in the SEM. A novel mixed-methods approach was employed to generate key areas to be addressed and informed statements for consensus consideration utilizing the modified Delphi model. Statements achieving strong consensus (> =75% agreement) were included in final equity frameworks addressing clinical/community engagement and research engagement.

RESULTS

All societal levels of the SEM (interpersonal, institutional, community, and policy/advocacy) must deliver information about PCA GT to Black males that address benefits/limitations, clinical impact, hereditary cancer implications, with acknowledgment of mistrust (mean scores [MS] 4.57-5.00). Interpersonal strategies for information delivery included engagement of family/friends/peers/Black role models to improve education/awareness and overcome mistrust (MS 4.65-5.00). Institutional strategies included diversifying clinical, research, and educational programs and integrating community liaisons into healthcare institutions (MS 4.57-5.00). Community strategies included partnerships with healthcare institutions and visibility of healthcare providers/researchers at community events (MS 4.65-4.91). Policy/advocacy included improving partnerships between advocacy and healthcare/community organizations while protecting patient benefits (MS 4.57-5.00). Media strategies were endorsed for the first time at every level (MS 4.56-5.00).

CONCLUSION

The SEM-based equity frameworks proposed provide the first multidisciplinary strategies dedicated to increase engagement of Black males in PCA GT, which are critical to reduce disparities in PCA-mortality through informing tailored screening, targeted therapy, and cascade testing in families.

Project GIVE: using a virtual genetics service platform to reduce health inequities and improve access to genomic care in an underserved region of Texas

BACKGROUND

The utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley (RGV) at the Texas-Mexico border is predominantly Hispanic/Latino with a high poverty rate and very limited access to genetic services. Funded by the National Center for Advancing Translational Sciences, Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to reduce the time to diagnosis and increase provider knowledge of genomics in this region, with the goal of improving pediatric health outcomes. We describe our experience of establishing a virtual pediatric genomic service in this region to expeditiously identify, recruit, and evaluate pediatric patients with undiagnosed diseases.

METHODS

We have utilized an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform called Consultagene to receive referrals from healthcare providers in the RGV. Using this portal, genetic services, including virtual evaluation and genome sequencing (GS), are being delivered to children with rare diseases. The study has also integrated effective methods to involve and educate community providers through in-person meetings and Continuing Professional Education (CPE) events.

RESULTS

The recruitment efforts have proven highly successful with the utilization of Consultagene in this medically underserved region. The project's ongoing engagement efforts with local healthcare providers have resulted in progressively more referrals to the study over time, thus improving inclusion and access to genomic care in the RGV. Additionally, the curated CPE content has been well received by healthcare providers in the region.

CONCLUSIONS

Project GIVE study has allowed advanced genetic evaluation and delivery of GS through the virtual Consultagene portal, effectively circumventing the recognized socioeconomic and logistical barriers to accessing genetic services within this border community.

BRCA genetic testing and counseling in breast cancer: how do we meet our patients' needs?

BRCA1 and BRCA2 are tumor suppressor genes that have been linked to inherited susceptibility of breast cancer. Germline BRCA1/2 pathogenic or likely pathogenic variants (gBRCAm) are clinically relevant for treatment selection in breast cancer because they confer sensitivity to poly(ADP-ribose) polymerase (PARP) inhibitors. BRCA1/2 mutation status may also impact decisions on other systemic therapies, risk-reducing measures, and choice of surgery. Consequently, demand for gBRCAm testing has increased. Several barriers to genetic testing exist, including limited access to testing facilities, trained counselors, and psychosocial support, as well as the financial burden of testing. Here, we describe current implications of gBRCAm testing for patients with breast cancer, summarize current approaches to gBRCAm testing, provide potential solutions to support wider adoption of mainstreaming testing practices, and consider future directions of testing.

Impact of Affordable Care Act Provisions on the Racial Makeup of Patients Enrolled at a Deep South, High-Risk Breast Cancer Clinic

PURPOSE

Black women are less likely to receive screening mammograms, are more likely to develop breast cancer at an earlier age, and more likely to die from breast cancer when compared to White women. Affordable Care Act (ACA) provisions decreased cost sharing for women's preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race.

METHODS

This retrospective, quasi-experimental study examined the ACA's impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003 to 02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI).

RESULTS

Two thousand seven hundred and sixty-seven patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05-1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97-1.01) but decreased by 17% per year for Black patients (IRR 0.83, 95% CI 0.74-0.92).

CONCLUSION

Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.

Genetic Testing Among Breast Cancer Patients in the Eastern Region of Saudi Arabia: Single-Center Experience

BACKGROUND

Genetic testing for persons with a heightened likelihood of harboring a germline mutation permits early identification and appropriate management. This study aimed to identify the proportion of breast cancer (BC) patients who were offered genetic testing and the prevalence of BRCA mutations among them. Additionally, we assessed the demographic and clinical features of BC patients in the Eastern Region of Saudi Arabia.

MATERIALS AND METHODS

Data from 2535 patients with BC were retrieved from the registry between 2017 and 2021. The data were analyzed and presented using univariate and bivariate statistics. Odds ratios and 95% confidence intervals using logistic regression analysis were computed to identify the predictors of BRCA testing.

RESULTS

Patients with BC ranged in age from 18 to 103 years, and the mean age was 49.60 ± 12.14 years. BC was detected in men in 29 (1.1%) cases. Among diagnosed patients with BC, a total of 96 (3.7%) patients underwent testing for BRCA gene mutations. Of them, 36 (37.5%) patients had a BRCA gene mutation. The likelihood of undergoing BRCA testing was higher for those who were diagnosed with the condition before the age of 50, patients who were referred from private institutions, and patients with a history of previously diagnosed cancer. The likelihood of conducting BRCA testing was significantly lower among those with distant metastases.

CONCLUSION

The proportion of BRCA testing among BC patients was found to be relatively low. The development of a cost-effective, locally developed risk assessment tool that incorporates genetic counseling and testing for those with a familial predisposition to BC is imperative.

Multimodal fusion learning for long QT syndrome pathogenic genotypes in a racially diverse population

Congenital long QT syndrome (LQTS) diagnosis is complicated by limited genetic testing at scale, low prevalence, and normal QT corrected interval in patients with high-risk genotypes. We developed a deep learning approach combining electrocardiogram (ECG) waveform and electronic health record data to assess whether patients had pathogenic variants causing LQTS. We defined patients with high-risk genotypes as having ≥1 pathogenic variant in one of the LQTS-susceptibility genes. We trained the model using data from United Kingdom Biobank (UKBB) and then fine-tuned in a racially/ethnically diverse cohort using Mount Sinai BioMe Biobank. Following group-stratified 5-fold splitting, the fine-tuned model achieved area under the precision-recall curve of 0.29 (95% confidence interval [CI] 0.28-0.29) and area under the receiver operating curve of 0.83 (0.82-0.83) on independent testing data from BioMe. Multimodal fusion learning has promise to identify individuals with pathogenic genetic mutations to enable patient prioritization for further work up.

Expanding access to genetic testing for pancreatic cancer

Among individuals with pancreatic ductal adenocarcinoma (PDAC) 5-10% have a pathogenic germline variant (PGV) in a PDAC susceptibility gene. Guidelines recommend genetic testing among all individuals with PDAC. Additionally, at-risk relatives of PDAC patients benefit from their own genetic education, risk assessment, and testing. Multigene panel testing (MGPT) can identify individuals with inherited cancer risk who can benefit from early cancer surveillance and risk reduction strategies. This manuscript discusses various healthcare delivery models for MGPT including traditional in-person genetic counseling, novel integrated in-person infrastructures, telemedicine genetics care via telephone- or video-visits and direct-to-consumer testing. Barriers and facilitators to care on the individual, provider, and system level are also outlined including specific considerations for historically marginalized communities.

Exploring patient experiences of surveillance for pancreatic cystic neoplasms: a qualitative study

BACKGROUND

Pancreatic cystic neoplasms (PCN) are considered premalignant conditions to pancreatic adenocarcinoma with varying degrees of cancerous potential. Management for individuals who do not require surgical treatment involves surveillance to assess for cancerous progression. Little is known about patients' experience and the impact of living with surveillance for these lesions.

AIMS

To explore the experiences of patients living with surveillance for PCNs.

METHODS

Semi-structured qualitative interviews were conducted with patients under surveillance for pancreatic cystic neoplasms in the UK. Age, gender, time from surveillance and surveillance method were used to purposively sample the patient group. Data were analysed using reflexive thematic analysis.

RESULTS

A PCN diagnosis is incidental and unexpected and for some, the beginning of a disruptive experience. How patients make sense of their PCN diagnosis is influenced by their existing understanding of pancreatic cancer, explanations from clinicians and the presence of coexisting health concerns. A lack of understanding of the diagnosis and its meaning for their future led to an overarching theme of uncertainty for the PCN population. Surveillance for PCN could be seen as a reminder of fears of PCN and cancer, or as an opportunity for reassurance.

CONCLUSIONS

Currently, individuals living with surveillance for PCNs experience uncertainty with a lack of support in making sense of a prognostically uncertain diagnosis with no immediate treatment. More research is needed to identify the needs of this population to make improvements to patient care and reduce negative experiences.

[Oncology in French Guiana: A challenge to win]

French Guiana is an equatorial, multicultural, overseas territory in South America. The region is unique: a wealthy country with a universal healthcare system, but significant poverty, which bears little resemblance to its neighbors Brazil and Suriname. Cancer is the second leading cause of death. The incidence of cancer is lower than in France, stages are generally more advanced and the prognosis worse. To date, oncology has been organized through a joint venture between local institutions and healthcare professionals and a cancer center in mainland France, in line with the recommendations of the Institut National du Cancer. The implementation of a medical project and a complete medical studies curriculum in French Guiana is a tremendous opportunity for the development of oncology. The main challenges are consolidating medical care for patients, quality control, genetic oncology, molecular biology, implementation of radiotherapy and nuclear medicine, clinical and translational research, and teaching programs. Working in oncology in French Guiana is exciting because of the scientific interest (particular characteristics of cancers, notably the role of viral or micro-organism-induced carcinogenesis, genetic factors in these populations with African and Asian roots, and the importance of a public health policy) and human interest (patients from different cultures; all of them bring original approaches to health and illness that need to be deciphered in order to offer quality care). This requires the support of healthcare professionals who are enthusiastic about this unique adventure.

Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England

BACKGROUND

Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation.

METHODS

We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates.

RESULTS

The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation.

CONCLUSIONS

For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups.

TRIAL REGISTRATION NUMBER

NCT05611632.

A qualitative feasibility study of a prototype patient-centered video intervention to increase uptake of cancer genetic testing among Black Americans

BACKGROUND

Health advances due to developments in genomic medicine are unequally experienced in the USA; racial differences in the uptake of genetic testing are one factor in this disparity. In collaboration with Black patients and diverse health care providers, we are developing a patient-centered video intervention to increase cancer genetic testing among eligible Black Americans. The objective of the pilot work is to explore the acceptability of and support for the intervention and key content components.

METHODS

In order to create a patient-centered video intervention prototype, we conducted a targeted, secondary analysis of 47 coded transcripts from video-taped qualitative interviews with people with a known genetic or inherited cancer risk. The review focused on decision-making, testing experiences, and perceived value of genetic testing. We subsequently generated a 15-min video montage of content from 9 diverse (age, gender, race) participants. We used the prototype video as prompt material for semi-structured interviews with 10 Black patients who had undergone genetic testing in the last 2 years and 10 racially diverse providers (genetic counselors, a nurse, and medical oncologists) who provide management recommendations for high-risk patients. Interviews sought to understand the acceptability of a video intervention to enhance informed decision-making by Black patients and key elements for intervention efficacy.

RESULTS

Study participants were generally positive about the prototype video and provided guidance for intervention development. Interviewed patients prioritized perceived authenticity and relatability of video participants. The presentation of patients' perspectives on testing, their experiences of testing, and the benefits of having test results were all seen as useful. The benefits of testing for self and family were identified as important considerations. Privacy concerns and science skepticism were identified as germane issues, with guidance to present barriers to testing alongside possible solutions. The inclusion of clinicians was seen as potentially useful but with caution that clinicians are not universally trusted.

CONCLUSIONS

Study findings provided critical input for the creation of a professionally produced, tailored intervention video for a randomized clinical trial with Black Americans to evaluate the influence on uptake of genetic testing. The interviews suggest the acceptability and potential utility of an authentic, realistic, and tailored, patient-centered video intervention to increase consideration and uptake of genetic testing.

The Need to Consider Context: A Systematic Review of Factors Involved in the Consent Process for Genetic Tests from the Perspective of Patients

Background: Informed consent for genetic tests is a well-established practice. It should be based on good quality information and in keeping with the patient's values. Existing informed consent assessment tools assess knowledge and values. Nevertheless, there is no consensus on what specific elements need to be discussed or considered in the consent process for genetic tests.Methods: We performed a systematic review to identify all factors involved in the decision-making and consent process about genetic testing, from the perspective of patients. Through public databases, we identified studies reporting factors that influence the decision to accept or decline genetic testing. Studies were included if they reported the perspective of patients or at-risk individuals. All articles were thematically coded.Results: 1989 articles were reviewed: 70 met inclusion criteria and 12 additional articles were identified through the references of included studies. Coding of the 82 articles led to the identification of 45 factors involved in decision-making and consent, which were initially divided into three domains: in favor of, against or with an undetermined influence on genetic testing. Each factor was also divided into three subdomains relating to the informed choice concept: knowledge, values or other. The factors in the "other" subdomain were all related to the context of testing (e.g. timing, cost, influence of family members, etc), and were present in all three domains.Conclusions: We describe the network of factors contributing to decision-making and consent process and identify the context of genetic testing as a third component to influence this process. Future studies should consider the evaluation of contextual factors as an important and relevant component of the consent and decision-making process about genetic tests. Based on these results, we plan to develop and test a more comprehensive tool to assess informed consent for genetic testing.

Disparities in Genetic Testing for Neurologic Disorders

BACKGROUND AND OBJECTIVES

Genetic testing is now the standard of care for many neurologic conditions. Health care disparities are unfortunately widespread in the US health care system, but disparities in the utilization of genetic testing for neurologic conditions have not been studied. We tested the hypothesis that access to and results of genetic testing vary according to race, ethnicity, sex, socioeconomic status, and insurance status for adults with neurologic conditions.

METHODS

We analyzed retrospective data from patients who underwent genetic evaluation and testing through our institution's neurogenetics program. We tested for differences between demographic groups in 3 steps of a genetic evaluation pathway: (1) attending a neurogenetic evaluation, (2) completing genetic testing, and (3) receiving a diagnostic result. We compared patients on this genetic evaluation pathway with the population of all neurology outpatients at our institution, using univariate and multivariable logistic regression analyses.

RESULTS

Between 2015 and 2022, a total of 128,440 patients were seen in our outpatient neurology clinics and 2,540 patients underwent genetic evaluation. Black patients were less than half as likely as White patients to be evaluated (odds ratio [OR] 0.49, p < 0.001), and this disparity was similar after controlling for other demographic factors in multivariable analysis. Patients from the least wealthy quartile of zip codes were also less likely to be evaluated (OR 0.67, p < 0.001). Among patients who underwent evaluation, there were no disparities in the likelihood of completing genetic testing, nor in the likelihood of a diagnostic result after adjusting for age. Analyses restricted to specific indications for genetic testing supported these findings.

DISCUSSION

We observed unequal utilization of our clinical neurogenetics program for patients from marginalized and minoritized demographic groups, especially Black patients. Among patients who do undergo evaluation, all groups benefit similarly from genetic testing when it is indicated. Understanding and removing barriers to accessing genetic testing will be essential to health care equity and optimal care for all patients with neurologic disorders.

Disparities in genetic testing for breast cancer among black and Hispanic women in the United States

Women from racial and ethnic minorities are at a higher risk for developing breast cancer. Despite significant advancements in breast cancer screening, treatment, and overall survival rates, disparities persist among Black and Hispanic women. These disparities manifest as breast cancer at an earlier age with worse prognosis, lower rates of genetic screening, higher rates of advanced-stage diagnosis, and higher rates of breast cancer mortality compared to Caucasian women. The underutilization of available resources, such as genetic testing, counseling, and risk assessment tools, by Black and Hispanic women is one of many reasons contributing to these disparities. This review aims to explore the racial disparities that exist in genetic testing among Black and Hispanic women. Barriers that contribute to racial disparities include limited access to resources, insufficient knowledge and awareness, inconsistent care management, and slow progression of incorporation of genetic data and information from women of racial/ethnic minorities into risk assessment models and genetic databases. These barriers continue to impede rates of genetic testing and counseling among Black and Hispanic mothers. Consequently, it is imperative to address these barriers to promote early risk assessment, genetic testing and counseling, early detection rates, and ultimately, lower mortality rates among women belonging to racial and ethnic minorities.

Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up

PURPOSE

Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months.

METHODS

We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms.

RESULTS

At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months.

CONCLUSION

TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA.

TRIAL REGISTRATION

This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.

A survey on awareness, knowledge and preferences toward genetic testing among the United States general public

Aim: To understand awareness, knowledge and preferences regarding genetic testing among the USA general public. Methods: A cross-sectional online survey using a Qualtrics Panel. Results: Among 1600 respondents, 545 (34%) were White, 411 (26%) Black, 412 (26%) Hispanic or Latin(x) and 232 (15%) Asian. Most had heard of ancestry testing (87%) and genetic health risk testing (69%), but a third thought inherited genes were only a little or not at all responsible for obesity (36%) and mental health (33%). The majority preferred pre-emptive pharmacogenetic testing (n = 74%) compared with reactive testing. Statistically significant differences between racial/ethnic groups and rural-urban respondents were observed. Conclusion: Most preferred pre-emptive pharmacogenetic testing; however, about one-quarter preferred reactive testing. Preferences should be discussed during patient-clinician interactions.

Developing a General Population Screening Programme for Paediatric Type 1 Diabetes: Evidence from a Qualitative Study of the Perspectives and Attitudes of Parents

Introduction

With reliable tests and preventative treatments now available the United Kingdom has introduced a prototype population-based paediatric (ages 3-13) screening programme for type 1 diabetes (T1D). To aid its ethical and sustainable implementation this work explores parental views around the concept of this programme to determine how their involvement might be encouraged and supported. Research Design and Methods. Qualitative interviews were undertaken with 38 parents and the data were analysed using a purposely developed "Burden of Screening" framework, which presented the data within three domains describing the various elements of screening participation; pre-screening tasks designated to participants; factors influencing engagement with screening; and consequences of screening participation.

Results

Regarding pre-screening tasks designated to participants, the importance of clear communication about the condition were apparent with parents expressing uncertainty of the benefits of screening against the potential anxiety engendered. In factors influencing their engagement with screening participants described their preference for less invasive testing techniques, the reassurance of structured support from healthcare professionals inherent within the programme, and the potential benefit of peer support. Regarding the consequences of screening participation parents described how a positive result might lead to overly protective behaviours, and anxiety from watching and waiting for the onset of symptomatic T1D.

Conclusions

The benefits of T1D screening need to be clearly communicated to facilitate uptake. To this end the use of decision-support tools and better targeted educational materials should be explored. Post-testing, parents expressed preferences for peer support and access to psychological counselling.

Genetic Testing for Cancer Risk and Perceived Importance of Genetic Information Among US Population by Race and Ethnicity: a Cross-sectional Study

BACKGROUND

Genetic testing can help determine the risk of many cancers and guide cancer prevention and treatment plans. Despite increasing concern about disparities in precision cancer medicine, public knowledge and cancer genetic testing by race and ethnicity have not been well investigated.

METHODS

We analyzed data from the 2020 Health Information National Trends Survey in 2022. Self-reported cancer genetic testing (e.g., Lynch syndrome, BRCA1/2) knowledge and utilization were compared by race and ethnicity. Perceived importance of genetic information for cancer care (prevention, detection, and treatment) was also examined in relation to the uptake of cancer genetic testing. Multivariable logistic regression models were employed to examine factors associated with knowledge and genetic testing to calculate predicted probability of undergoing genetic testing by race and ethnicity.

RESULTS

Of 3551 study participants, 37.8% reported having heard of genetic testing for cancer risk and 3.9% stated that they underwent cancer genetic testing. Being non-Hispanic Black (OR=0.47, 95% CI=0.30-0.75) or Hispanic (OR=0.56, CI=0.35-0.90) was associated with lower odds of genetic testing knowledge. Although Hispanic or non-Hispanic Black respondents were more likely to perceive higher importance of genetic information versus non-Hispanic Whites, they had a lower predicted probability of cancer genetic testing.

CONCLUSION

Non-Hispanic Black and Hispanic adults had lower knowledge and were less likely to undergo cancer genetic testing than non-Hispanic Whites. Further research is needed on sources of genetic testing information for racial and ethnic minorities and the barriers to accessing genetic testing to inform the development of effective cancer risk genetic testing promotion.

Germline and somatic testing for ovarian Cancer: An SGO clinical practice statement

Germline and somatic genetic testing have become critical components of care for people with ovarian cancer. The identification of germline and somatic pathogenic variants as well as homologous recombination deficiency can contribute to the prediction of treatment response, prognostic outcome, and suitability for targeted agents (e.g. poly (ADP-ribose) polymerase (PARP) inhibitors). Furthermore, identifying germline pathogenic variants can prompt cascade genetic testing for at-risk relatives. Despite the clinical benefits and consensus recommendations from several organizations calling for universal genetic testing in ovarian cancer, only about one third of patients complete germline or somatic genetic testing. The members of the Society of Gynecologic Oncology (SGO) Clinical Practice Committee have composed this statement to provide an overview of germline and somatic genetic testing for patients with epithelial ovarian cancer, focusing on available testing modalities and options for care delivery.

A review of racial disparities in ovarian cancer and clinical trials

PURPOSE OF REVIEW

Ovarian cancer ranks fifth in mortality among women with cancer and accounts for more death compared to any other gynecological cancers. This review summarizes the most recent literature on disparities in ovarian cancer as well as within recent clinical trials.

RECENT FINDINGS

Recent studies have identified a notable disparity in genetic testing utilization, disease stage at the time of diagnosis, and adherence to treatment guidelines between Black women and their White counterparts, ultimately leading to increased mortality rates among Black women from ovarian cancer. Additionally, there is an underreporting of race in clinical trials and those that do report race demonstrate significant racial disparities within trial participants with the majority of participants being White.

SUMMARY

It is imperative that we address the significant racial disparities within ovarian cancer and clinical trials to establish a framework of equitable healthcare provision. Multiple determinants, such as implicit bias, provider mistrust, accessibility hurdles, and socioeconomic influences, appear to contribute to the current disparities faced by women of color. Further investigation is warranted, encompassing a deeper understanding of diverse patient perspectives and identifying barriers to receiving optimal care and participating in clinical trials.

Transgender identity genetic research: Attitudes, opinions & beliefs among members of the transgender and gender diverse communities

Background: There is growing interest in investigating genetic explanations for transgender identity. In the spirit of a Community-Engaged Research Framework, which highlights the importance of involving community members who would be impacted by research throughout the entire research process, it is important for researchers to understand transgender and gender expansive individuals' views and concerns regarding the potential harms and benefits of transgender identity genetic research (TIGR). Aim: To evaluate the thoughts, opinions, and beliefs in the transgender and gender diverse communities toward TIGR Methods: We conducted an online survey study, asking 409 transgender and gender diverse individuals about their views regarding potential benefits and risks of TIGR. Results: Participants demonstrated a mixture of positive and negative opinions on the search for a genetic contribution to gender identity. Overall, there was a slight trend toward more positive views, with 71% agreeing or strongly agreeing that TIGR made them feel hopeful. Discussion: Given the varied and nuanced views held within the transgender and gender diverse communities toward transgender genetic research, we hope that this study can be one of many evaluating this topic, and that our findings, and those of future studies, can serve as a foundation for conducting transgender genetic research in a way that is in alignment with the ethos and priorities of the transgender and gender diverse communities.

Racial differences in knowledge, attitudes, and sources of information about germline cancer genetic testing in the U.S.A.: An analysis of the health information National Trends Survey System

PURPOSE

To understand racial disparities in germline cancer genetic testing and the role of prior knowledge, attitudes, and sources of information.

METHODS

A cross-sectional analysis of the Health Information National Trends Survey 5 (HINTS 5) was conducted between February 24th and June 15th, 2020. The study aimed to investigate knowledge and receipt of genetic testing, attitudes toward the importance of genetic testing in preventing, detecting, and treating cancer, and information sources of genetic testing in the United States of America.

RESULTS

Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with lower odds of being informed about genetic testing, whereas those of NHB race were more likely to endorse the importance of genetic testing in cancer prevention and treatment. Regarding sources of information about genetic testing: Non-Hispanic Asians were less likely to be informed about genetic testing from television (Mean Predicted Probability (MPP) 0.38 95%CI; 0.21-0.55, (Adjusted Risk Difference) ARD vs. Non-Hispanic White (NHW); -0.228, p = 0.01), NHB were less likely to report being informed about genetic testing from social media (MPP 0.27 95%CI; 0.20-0.34, ARD vs. NHW; -0.139, p < 0.01).

CONCLUSIONS

NHB and Hispanic groups face unequal access to information about genetic testing. There are significant race-based differences in information sources. These differences could be used to promote equitable access to cancer genetic testing.

Experience in Accessing Healthcare in Ethnic Minority Patients with Chronic Respiratory Diseases: A Qualitative Meta-Synthesis

BACKGROUND

Access to healthcare is part of every individual's human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why healthcare disparities occur with patients from a minority background has the potential to improve health equality and care quality. This qualitative systematic review aims to gain insights into the experiences of people with chronic respiratory diseases (CRDs) from a minority background and explore factors contributing to their experiences in accessing healthcare to inform related health policy makers and healthcare providers.

METHODS

This systematic review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, where the Joanna Briggs Institute meta-aggregative instrument facilitated the qualitative synthesis. The study protocol was registered with PROSPERO (CRD42022346055). PubMed, Scopus, Web of Science, and CINAHL were the databases explored.

RESULTS

From the papers selected, 47 findings were derived from 10 included studies, and four synthesised findings were generated: (1) the relationship between patients and healthcare professionals affects the usage of healthcare services; (2) patients' perceptions and cultural beliefs affect their compliance with disease management; (3) personal behaviours affect the usage of healthcare services; and (4) health resource inequalities have an impact on accessing healthcare services.

CONCLUSIONS

This systematic review demonstrates that ethnic minorities with CRDs face inequalities when engaging in healthcare. The relationship between patients and clinicians impacting the use of healthcare is the most pivotal discovery, where not speaking the same language and being of a different race alongside the accompanying criticism and faith in facilities are key contributors to this effect. In addition, the thinking patterns of these marginalised groups may reflect their cultural upbringing and diminish their engagement with therapies. This paper has uncovered ways to attenuate inequalities amongst ethnic minorities in engaging with healthcare providers and provides insight into building effective equity-promoting interventions in healthcare systems. To overcome these disparities, coaching doctors to communicate better with minority cohorts could help such patients to be more comfortable in connecting with medical facilities.

Reducing Time to Diagnosis of Rare Genetic Diseases in a Medically Underserved Hispanic Population- Lessons Learned for Meaningful Engagement

Background

The utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley at the Texas-Mexico border is predominantly Hispanic with a high poverty rate and an increased prevalence of birth defects, with very limited access to genetics services. The cost of a diagnosis is often times out of reach for these underserved families. Funded by the National Center for Advancing Translational Sciences (NCATS), Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to shorten the time to diagnosis and alleviate healthcare inequities in this region, with the goal of improving pediatric health outcomes.

Methods

Utilizing Consultagene, an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform, we designed the study to recruit 100 children with rare diseases over a period of two years from this region, through peer-to-peer consultation and referral.

Conclusions

Project GIVE study has allowed advanced genetic evaluation and delivery of genome sequencing through the virtual portal, effectively circumventing the recognized socioeconomic and other barriers within this population. This paper explores the successful community engagement process and implementation of an alternate genomics evaluation platform and testing approach, aiming to reduce the diagnostic journey for individuals with rare diseases residing in a medically underserved region.

Longitudinal Natural History Study of Children and Adults with Rare Solid Tumors: Initial Results for First 200 Participants

Understanding of tumor biology and identification of effective therapies is lacking for many rare tumors. My Pediatric and Adult Rare Tumor (MyPART) network was established to engage patients, advocates, and researchers and conduct a comprehensive longitudinal Natural History Study of Rare Solid Tumors. Through remote or in-person enrollment at the NIH Clinical Center, participants with rare solid tumors ≥4 weeks old complete standardized medical and family history forms, patient reported outcomes, and provide tumor, blood and/or saliva samples. Medical records are extracted for clinical status and treatment history, and tumors undergo genomic analysis. A total of 200 participants (65% female, 35% male, median age at diagnosis 43 years, range = 2-77) enrolled from 46 U.S. states and nine other countries (46% remote, 55% in-person). Frequent diagnoses were neuroendocrine neoplasms (NEN), adrenocortical carcinomas (ACC), medullary thyroid carcinomas (MTC), succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumors (sdGIST), and chordomas. At enrollment, median years since diagnosis was 3.5 (range = 0-36.6), 63% participants had metastatic disease and 20% had no evidence of disease. Pathogenic germline and tumor mutations included SDHA/B/C (sdGIST), RET (MTC), TP53 and CTNNB1 (ACC), MEN1 (NEN), and SMARCB1 (poorly-differentiated chordoma). Clinically significant anxiety was observed in 20%-35% of adults. Enrollment of participants and comprehensive data collection were feasible. Remote enrollment was critical during the COVID-19 pandemic. Over 30 patients were enrolled with ACC, NEN, and sdGIST, allowing for clinical/genomic analyses across tumors. Longitudinal follow-up and expansion of cohorts are ongoing to advance understanding of disease course and establish external controls for interventional trials.

SIGNIFICANCE

This study demonstrates that comprehensive, tumor-agnostic data and biospecimen collection is feasible to characterize different rare tumors, and speed progress in research. The findings will be foundational to developing external controls groups for single-arm interventional trials, where randomized control trials cannot be conducted because of small patient populations.

Predictors of correct recall of genetic risk information among Hispanic individuals in Florida and Puerto Rico

OBJECTIVE

To identify predictors of genetic risk recall and examine whether recall influences adoption of skin cancer preventive behaviors among Hispanic individuals.

METHODS

Hispanic participants randomized to intervention arms (n = 463) of a precision prevention trial were provided MC1R risk information (average, higher) and asked to recall their risk after 3 and 9 months. Predictors of recall (correct versus did not recall/misremembered) were determined by backwards stepwise logistic regression. Intervention effects on preventive behaviors were estimated within strata of 3-month recall.

RESULTS

Age inversely predicted correct recall in both risk groups (average: OR3-months(3)= 0.97, 95%CI:0.94-1.01, OR9-months(9)= 0.96, 95%CI:0.93-0.99; higher: OR3 = 0.98, 95%CI:0.95-1.01, OR9 = 0.98, 95%CI:0.95-1.00). Education positively predicted recall among participants at average risk (OR3 =1.64, 95%CI:1.06-2.63, OR9 =1.73, 95%CI:1.12-2.81). Darker untanned skin color inversely predicted recall among participants at higher risk (OR3 =0.68, 95%CI:0.45-0.99, OR9 =0.74, 95%CI:0.50-1.09). Intervention effects for routine sunscreen use and undergoing a clinical skin exam were stronger among participants at higher risk who correctly recalled at 3 months than those who did not recall/misremembered.

CONCLUSIONS

Younger age, higher education, and lighter untanned skin color predicted correct recall. Better recall may improve skin cancer prevention outcomes.

PRACTICE IMPLICATIONS

Additional strategies are needed to boost recall among Hispanic individuals who are older, less educated, and darker-skinned.

Attitudes towards genetic testing: The role of genetic literacy, motivated cognition, and socio-demographic characteristics

Understanding reasons for why people choose to have or not to have a genetic test is essential given the ever-increasing use of genetic technologies in everyday life. The present study explored the multiple drivers of people's attitudes towards genetic testing. Using the International Genetic Literacy and Attitudes Survey (iGLAS), we collected data on: (1) willingness to undergo testing; (2) genetic literacy; (3) motivated cognition; and (4) demographic and cultural characteristics. The 37 variables were explored in the largest to-date sample of 4311 participants from diverse demographic and cultural backgrounds. The results showed that 82% of participants were willing to undergo genetic testing for improved treatment; and over 73%-for research. The 35 predictor variables together explained only a small proportion of variance: 7%-in the willingness to test for Treatment; and 6%-for Research. The strongest predictors of willingness to undergo genetic testing were genetic knowledge and deterministic beliefs. Concerns about data misuse and about finding out unwanted health-related information were weakly negatively associated with willingness to undergo genetic testing. We also found some differences in factors linked to attitudes towards genetic testing across the countries included in this study. Our study demonstrates that decision-making regarding genetic testing is influenced by a large number of potentially interacting factors. Further research into these factors may help consumers to make decisions regarding genetic testing that are right for their specific circumstances.