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Whitaker KD, Obeid E, Daly MB, Hall MJ. Cascade Genetic Testing for Hereditary Cancer Risk: An Underutilized Tool for Cancer Prevention. JCO Precis Oncol 2022; 5:1387-1396. [PMID: 34994636 DOI: 10.1200/po.21.00163] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
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Suttman A, Pilarski R, Agnese DM, Senter L. "Second-Class Status?" Insight into Communication Patterns and Common Concerns Among Men with Hereditary Breast and Ovarian Cancer Syndrome. J Genet Couns 2018; 27:885-893. [PMID: 29404823 DOI: 10.1007/s10897-018-0214-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/09/2018] [Indexed: 01/06/2023]
Abstract
Hereditary breast and ovarian cancer syndrome (HBOC) is a cancer predisposition syndrome that affects both men and women, with more significant cancer risk elevations in women. Dissemination patterns regarding familial genetic risk information among females with HBOC are fairly well defined, but knowledge about how males share this information is limited. We interviewed 21 people primarily Ashkenazi Jewish men who were accrued via listserv email through Facing Our Risk of Cancer Empowered (FORCE). Interviews focused on family cancer history, experiences with cancer and genetic testing, motivations to pursue genetic testing and subsequently disclose genetic test results, information-sharing patterns, health care provider response, and participants' emotional support systems. The interviews were transcribed in their entirety, coded, and analyzed based on recurring themes. Eighteen transcripts were used for the analysis. Results were classified into five main themes. Participants (n = 8) were most concerned about cancer risk for their children and female family members, and most (n = 11) mentioned that HBOC provides them increased personal awareness, but has a negligible impact on their life overall (n = 9). Men (n = 11) were interested in a male-focused support group to discuss HBOC and gain knowledge and information. Participants (n = 9) took on active and open communication roles with family members and health care providers. The majority of participants (n = 14) discussed the need for knowledge and awareness among the health care community and general population regarding male HBOC risks. This study serves as a pilot study and provides important and novel insights into psychosocial impacts, communication patterns, encounters with health care professionals, and expressed needs of males with HBOC.
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Affiliation(s)
- Alexandra Suttman
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Pediatrics, Department of Hematology, Oncology, and Bone Marrow Transplant, Children's Hospital Colorado, 13123 E. 16th Ave, B115, Aurora, CO, 80045, USA.
| | - Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Doreen M Agnese
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Wiens ME, Wilson BJ, Honeywell C, Etchegary H. A family genetic risk communication framework: guiding tool development in genetics health services. J Community Genet 2013; 4:233-42. [PMID: 23319393 PMCID: PMC3666832 DOI: 10.1007/s12687-012-0134-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 12/20/2012] [Indexed: 12/20/2022] Open
Abstract
Family communication of genetic risk information is a complex process. Currently, there are no evidence-based interventions to help genetics professionals facilitate the process of disclosure within families. This study was designed to create a framework to assist in the development of tools to support patients in communicating genetic risk information to family members. A systematic review identified the factors relevant in communicating genetic risk information in families. A guiding theory for the proposed framework was selected and populated with the factors identified from the review. The review identified 112 factors of relevance. The theory of planned behaviour was selected to guide framework development, organising the framework in terms of the patient's attitudes about disclosure, perceived pressure to disclose and perceived control over disclosure. Attitudes about disclosure are influenced by a desire to protect oneself or family members, and the patient's perceptions of relevance of the information for family members, responsibility to disclose, family members' rights to information and the usefulness of communicating. Perceived pressure to disclose information is shaped by genetic professionals, family members and society. Perceived control over disclosure is affected by family relationships/dynamics, personal communication skills, the ability of the patient and family to understand the information and coping skills of the patient and family member. The family genetic risk communication framework presents a concise synthesis of the evidence on family communication of genetic information; it may be useful in creating and evaluating tools to help genetic counsellors and patients with communication issues.
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Affiliation(s)
- Miriam E Wiens
- CF Health Services Group Headquarters, Department of National Defence, 1745 Alta Vista Drive, Ottawa, ON, Canada, K1A 0K6,
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Do Breast Cancer Patients Tested in the Oncology Care Setting Share BRCA Mutation Results with Family Members and Health Care Providers? J Cancer Epidemiol 2012; 2012:498062. [PMID: 22848222 PMCID: PMC3403073 DOI: 10.1155/2012/498062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/25/2012] [Indexed: 01/05/2023] Open
Abstract
BRCA genetic test results provide important information to manage cancer risk for patients and their families. Little is known on the communication of genetic test results by mutation status with family members and physicians in the oncology care setting. As part of a longitudinal study evaluating the impact of genetic counseling and testing among recently diagnosed breast cancer patients, we collected patients' self-reported patterns of disclosure. Descriptive statistics characterized the sample and determined the prevalence of disclosure of BRCA test results to family members and physicians. Of 100 patients who completed the baseline and the 6-month followup survey, 77 reported pursuing testing. The majority shared test results with female first-degree relatives; fewer did with males. Participants were more likely to share results with oncologists compared to surgeons, primary care physicians, or other specialty physicians. These findings suggest that while breast cancer patients may communicate results to at-risk female family members and their medical oncologist, they may need education and support to facilitate communication to other first-degree relatives and providers.
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Fischer C, Engel C, Sutter C, Zachariae S, Schmutzler R, Meindl A, Heidemann S, Grimm T, Goecke TO, Debatin I, Horn D, Wieacker P, Gadzicki D, Becker K, Schäfer D, Stock F, Voigtländer T. BRCA1/2testing: uptake, phenocopies, and strategies to improve detection rates in initially negative families. Clin Genet 2011; 82:478-83. [DOI: 10.1111/j.1399-0004.2011.01788.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ardern-Jones A, Kenen R, Lynch E, Doherty R, Eeles R. Is no news good news? Inconclusive genetic test results in BRCA1 and BRCA2 from patients and professionals' perspectives. Hered Cancer Clin Pract 2010; 8:1. [PMID: 20180951 PMCID: PMC2832891 DOI: 10.1186/1897-4287-8-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/12/2010] [Indexed: 12/14/2022] Open
Abstract
Background Women from families with a high risk of breast or ovarian cancer in which genetic testing for mutations in the BRCA1/2 genes is inconclusive are a vulnerable and understudied group. Furthermore, there are no studies of the professional specialists who treat them - geneticists, genetic counsellors/nurses, oncologists, gynaecologists and breast surgeons. Methods We conducted a small qualitative study that investigated women who had developed breast cancer under the age of 45 and who had an inconclusive BRCA1/2 genetic diagnostic test (where no mutations or unclassified variants were identified). We arranged three focus groups for affected women and their close female relatives - 13 women took part. We also interviewed 12 health professionals who were involved in the care of these women. Results The majority of the women had a good grasp of the meaning of their own or a family member's inconclusive result, but a few indicated some misunderstanding. Most of the women in this study underwent the test for the benefit of others in the family and none mentioned that they were having the test purely for themselves. A difficult issue for sisters of affected women was whether or not to undertake prophylactic breast surgery. The professionals were sensitive to the difficulties in explaining an inconclusive result. Some felt frustrated that technology had not as yet provided them with a better tool for prediction of risk. Conclusions Some of the women were left with the dilemma of what decision to make regarding medical management of their cancer risk. For the most part, the professionals believed that the women should be supported in whatever management decisions they considered best, provided these decisions were based on a complete and accurate understanding of the genetic test that had taken place in the family.
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Affiliation(s)
| | - Regina Kenen
- The College of New Jersey, Department of Sociology and Anthropology, New Jersey, USA
| | - Elly Lynch
- The Royal Marsden NHS Foundation Trust, Downs Road, Surrey, UK.,Austin Hospital, Melbourne, Australia
| | - Rebecca Doherty
- The Institute of Cancer Research, 15 Cotswold Rd, Surrey, UK
| | - Rosalind Eeles
- The Institute of Cancer Research, 15 Cotswold Rd, Surrey, UK.,The Royal Marsden NHS Foundation Trust, Downs Road, Surrey, UK
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Koehly LM, Peters JA, Kenen R, Hoskins LM, Ersig AL, Kuhn NR, Loud JT, Greene MH. Characteristics of health information gatherers, disseminators, and blockers within families at risk of hereditary cancer: implications for family health communication interventions. Am J Public Health 2009; 99:2203-9. [PMID: 19833996 PMCID: PMC2775786 DOI: 10.2105/ajph.2008.154096] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Given the importance of the dissemination of accurate family history to assess disease risk, we characterized the gatherers, disseminators, and blockers of health information within families at high genetic risk of cancer. METHODS A total of 5466 personal network members of 183 female participants of the Breast Imaging Study from 124 families with known mutations in the BRCA1/2 genes (associated with high risk of breast, ovarian, and other types of cancer) were identified by using the Colored Eco-Genetic Relationship Map (CEGRM). Hierarchical nonlinear models were fitted to characterize information gatherers, disseminators, and blockers. RESULTS Gatherers of information were more often female (P<.001), parents (P<.001), and emotional support providers (P<.001). Disseminators were more likely female first- and second-degree relatives (both P<.001), family members in the older or same generation as the participant (P<.001), those with a cancer history (P<.001), and providers of emotional (P<.001) or tangible support (P<.001). Blockers tended to be spouses or partners (P<.001) and male, first-degree relatives (P<.001). CONCLUSIONS Our results provide insight into which family members may, within a family-based intervention, effectively gather family risk information, disseminate information, and encourage discussions regarding shared family risk.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, Building 31, Room B1B37D, 31 Center Drive-MSC 2073, Bethesda, MD 20892, USA.
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Fossland VS, Stroop JB, Schwartz RC, Kurtzman SH. Genetic Issues in Patients with Breast Cancer. Surg Oncol Clin N Am 2009; 18:53-71, viii. [DOI: 10.1016/j.soc.2008.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lessick M. Genetic testing for breast and ovarian cancer: ethical, legal, and psychosocial considerations. Nurs Womens Health 2007; 11:390-9; quiz 400-1. [PMID: 17883756 DOI: 10.1111/j.1751-486x.2007.00204.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Mira Lessick
- College of Nursing, University of Toledo, Toledo, OH, USA
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