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Barnes DR, Tyrer JP, Dennis J, Leslie G, Bolla MK, Lush M, Aeilts AM, Aittomäki K, Andrieu N, Andrulis IL, Anton-Culver H, Arason A, Arun BK, Balmaña J, Bandera EV, Barkardottir RB, Berger LP, de Gonzalez AB, Berthet P, Białkowska K, Bjørge L, Blanco AM, Blok MJ, Bobolis KA, Bogdanova NV, Brenton JD, Butz H, Buys SS, Caligo MA, Campbell I, Castillo C, Claes KB, Colonna SV, Cook LS, Daly MB, Dansonka-Mieszkowska A, de la Hoya M, deFazio A, DePersia A, Ding YC, Domchek SM, Dörk T, Einbeigi Z, Engel C, Evans DG, Foretova L, Fortner RT, Fostira F, Foti MC, Friedman E, Frone MN, Ganz PA, Gentry-Maharaj A, Glendon G, Godwin AK, González-Neira A, Greene MH, Gronwald J, Guerrieri-Gonzaga A, Hamann U, Hansen TV, Harris HR, Hauke J, Heitz F, Hogervorst FB, Hooning MJ, Hopper JL, Huff CD, Huntsman DG, Imyanitov EN, Izatt L, Jakubowska A, James PA, Janavicius R, John EM, Kar S, Karlan BY, Kennedy CJ, Kiemeney LA, Konstantopoulou I, Kupryjanczyk J, Laitman Y, Lavie O, Lawrenson K, Lester J, Lesueur F, Lopez-Pleguezuelos C, Mai PL, Manoukian S, May T, McNeish IA, Menon U, Milne RL, Modugno F, Mongiovi JM, Montagna M, Moysich KB, Neuhausen SL, Nielsen FC, Noguès C, Oláh E, Olopade OI, Osorio A, Papi L, Pathak H, Pearce CL, Pedersen IS, Peixoto A, Pejovic T, Peng PC, Peshkin BN, Peterlongo P, Powell CB, Prokofyeva D, Pujana MA, Radice P, Rashid MU, Rennert G, Richenberg G, Sandler DP, Sasamoto N, Setiawan VW, Sharma P, Sieh W, Singer CF, Snape K, Sokolenko AP, Soucy P, Southey MC, Stoppa-Lyonnet D, Sutphen R, Sutter C, Teixeira MR, Terry KL, Thomsen LCV, Tischkowitz M, Toland AE, Van Gorp T, Vega A, Velez Edwards DR, Webb PM, Weitzel JN, Wentzensen N, Whittemore AS, Winham SJ, Wu AH, Yadav S, Yu Y, Ziogas A, Berchuck A, Couch FJ, Goode EL, Goodman MT, Monteiro AN, Offit K, Ramus SJ, Risch HA, Schildkraut JM, Thomassen M, Simard J, Easton DF, Jones MR, Chenevix-Trench G, Gayther SA, Antoniou AC, Pharoah PD. Large-scale genome-wide association study of 398,238 women unveils seven novel loci associated with high-grade serous epithelial ovarian cancer risk. medRxiv 2024:2024.02.29.24303243. [PMID: 38496424 PMCID: PMC10942532 DOI: 10.1101/2024.02.29.24303243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Nineteen genomic regions have been associated with high-grade serous ovarian cancer (HGSOC). We used data from the Ovarian Cancer Association Consortium (OCAC), Consortium of Investigators of Modifiers of BRCA1/BRCA2 (CIMBA), UK Biobank (UKBB), and FinnGen to identify novel HGSOC susceptibility loci and develop polygenic scores (PGS). Methods We analyzed >22 million variants for 398,238 women. Associations were assessed separately by consortium and meta-analysed. OCAC and CIMBA data were used to develop PGS which were trained on FinnGen data and validated in UKBB and BioBank Japan. Results Eight novel variants were associated with HGSOC risk. An interesting discovery biologically was finding that TP53 3'-UTR SNP rs78378222 was associated with HGSOC (per T allele relative risk (RR)=1.44, 95%CI:1.28-1.62, P=1.76×10-9). The optimal PGS included 64,518 variants and was associated with an odds ratio of 1.46 (95%CI:1.37-1.54) per standard deviation in the UKBB validation (AUROC curve=0.61, 95%CI:0.59-0.62). Conclusions This study represents the largest GWAS for HGSOC to date. The results highlight that improvements in imputation reference panels and increased sample sizes can identify HGSOC associated variants that previously went undetected, resulting in improved PGS. The use of updated PGS in cancer risk prediction algorithms will then improve personalized risk prediction for HGSOC.
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Affiliation(s)
- Daniel R. Barnes
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan P. Tyrer
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Goska Leslie
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amber M. Aeilts
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University, Columbus, OH, USA
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Nadine Andrieu
- Inserm U900, Paris, France
- Institut Curie, Paris, France
- Mines ParisTech, Fontainebleau, France
- PSL Research University, Paris, France
| | - Irene L. Andrulis
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Hoda Anton-Culver
- Department of Epidemiology, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, CA, USA
| | - Adalgeir Arason
- Department of Pathology, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
- BMC (Biomedical Centre), Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Banu K. Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medical Oncology, University Hospital of Vall d’Hebron, Barcelona, Spain
| | - Elisa V. Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rosa B. Barkardottir
- Department of Pathology, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
- BMC (Biomedical Centre), Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lieke P.V. Berger
- University Medical Center Groningen, Department of Genetics, University of Groningen, Groningen, The Netherlands
| | | | - Pascaline Berthet
- Département de Biopathologie, Centre François Baclesse, Caen, France
| | - Katarzyna Białkowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Line Bjørge
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amie M. Blanco
- Cancer Genetics and Prevention Program, University of California San Francisco, San Francisco, CA, USA
| | - Marinus J. Blok
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kristie A. Bobolis
- City of Hope Clinical Cancer Genetics Community Research Network, Duarte, CA, USA
| | - Natalia V. Bogdanova
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus
| | - James D. Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
- National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Oncology Biobank, National Institute of Oncology, Budapest, Hungary
| | - Saundra S. Buys
- Department of Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | | | - Ian Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carmen Castillo
- Hereditary Cancer Program, IDIBELL (Bellvitge Biomedical Research Institute), Catalan Institute of Oncology, Barcelona, Spain
| | - Kathleen B.M. Claes
- Centre for Medical Genetics, Ghent University, Gent, Belgium
- Department of Biomolecular Medicine, University of Ghent, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | | | - EMBRACE Collaborators
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah V. Colonna
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Linda S. Cook
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Agnieszka Dansonka-Mieszkowska
- Department of Pathology and Laboratory Medicine, Institute of Oncology and Maria Sklodowska-Curie Cancer Center, Warsaw, Poland
| | - Miguel de la Hoya
- Molecular Oncology Laboratory, CIBERONC, Hospital Clinico San Carlos, IdISSC (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos), Madrid, Spain
| | - Anna deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Allison DePersia
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL, USA
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yuan Chun Ding
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Susan M. Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Zakaria Einbeigi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - D. Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester Universities Foundation Trust, St. Mary’s Hospital, Manchester, UK
- Genomic Medicine, North West Genomics hub, Manchester Academic Health Science Centre, Manchester Universities Foundation Trust, St. Mary’s Hospital, Manchester, UK
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Renée T. Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research ‘Demokritos’, Athens, Greece
| | | | - Eitan Friedman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Assuta Medical Center, Tel-Aviv, Israel
| | - Megan N. Frone
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Patricia A. Ganz
- Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Centre, UCLA, Los Angeles, CA, USA
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anna González-Neira
- Human Genotyping Unit-CeGen, Spanish National Cancer Research Centre, Madrid, Spain
- Spanish Network on Rare Diseases, Madrid, Spain
| | - Mark H. Greene
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Jacek Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Aliana Guerrieri-Gonzaga
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas v.O. Hansen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jan Hauke
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Frans B.L. Hogervorst
- Family Cancer Clinic, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Maartje J. Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chad D Huff
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David G. Huntsman
- British Columbia’s Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Evgeny N. Imyanitov
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, St. Petersburg, Russia
| | - kConFab Investigators
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Izatt
- Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Paul A. James
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Center and the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ramunas Janavicius
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Center, Oncogenetics Unit, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Esther M. John
- Department of Epidemiology & Population Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Siddhartha Kar
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Beth Y. Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine J. Kennedy
- Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research ‘Demokritos’, Athens, Greece
| | - Jolanta Kupryjanczyk
- Department of Pathology and Laboratory Medicine, Institute of Oncology and Maria Sklodowska-Curie Cancer Center, Warsaw, Poland
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ofer Lavie
- Technion-Israel Institute of Technology, Haifa, Israel
- Carmel Medical Center, Haifa, Israel
| | - Kate Lawrenson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women’s Cancer Program at the Samuel Oschin Cancer Institute Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jenny Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fabienne Lesueur
- Inserm U900, Paris, France
- Institut Curie, Paris, France
- Mines ParisTech, Fontainebleau, France
- PSL Research University, Paris, France
| | - Carlos Lopez-Pleguezuelos
- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
- Escola de Doutoramento Internacional, Universidade de Santiago, Santiago de Compostela, Spain
| | - Phuong L. Mai
- Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Taymaa May
- Princess Margaret Cancer Center, Toronto, Canada
| | - Iain A. McNeish
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Roger L. Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Francesmary Modugno
- Womens Cancer Research Center, Magee-Womens Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer M. Mongiovi
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Finn C. Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Catherine Noguès
- Département d’Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
- Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Edit Oláh
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | | | - Ana Osorio
- Spanish Network on Rare Diseases, Madrid, Spain
- Familial Cancer Clinical Unit, Human Cancer Genetics Programme, Madrid, Spain
| | - Laura Papi
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, Medical Genetics Unit, University of Florence, Florence, Italy
| | - Harsh Pathak
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Celeste L. Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Inge S. Pedersen
- Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ana Peixoto
- Department of Laboratory Genetics, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
| | - Tanja Pejovic
- Department of Obstetrics & Gynecology, Providence Medical Center, Medford, OR, USA
- Providence Cancer Center, Medford, OR, USA
| | - Pei-Chen Peng
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Paolo Peterlongo
- Genome Diagnostics Program, IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
| | - C. Bethan Powell
- Hereditary Cancer Program, Kaiser Permanente Northern California, San Francisco, CA, USA
| | | | - Miquel Angel Pujana
- ProCURE, IDIBELL (Bellvitge Biomedical Research Institute), Catalan Institute of Oncology, Barcelona, Spain
- ProCURE, IDIBGI (Girona Biomedical Research Institute), Catalan Institute of Oncology, Girona, Spain
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Muhammad U. Rashid
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Gad Rennert
- Technion-Israel Institute of Technology, Haifa, Israel
- The Association for Promotion of Research in Precision Medicine, Haifa, Israel
| | - George Richenberg
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Rockville, MD, USA
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Veronica W. Setiawan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Priyanka Sharma
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, Westwood, KS, USA
| | - Weiva Sieh
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christian F. Singer
- Dept of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Katie Snape
- Medical Genetics Unit, St George’s, University of London, London, UK
| | - Anna P. Sokolenko
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, St. Petersburg, Russia
| | - Penny Soucy
- Genomics Center, Centre Hospitalier Universitaire de Québec – Université Laval Research Center, Québec City, QC, Canada
| | - Melissa C. Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Clinical Pathology, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, Victoria, Australia
| | - Dominique Stoppa-Lyonnet
- Genetics Department, Institut Curie, Paris, France
- Unité INSERM U830, Paris, France
- Université Paris Cité, Paris, France
| | - Rebecca Sutphen
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel R. Teixeira
- Department of Laboratory Genetics, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center, Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Kathryn L. Terry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Liv Cecilie V. Thomsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Norway
| | - Marc Tischkowitz
- Program in Cancer Genetics, Departments of Human Genetics and Oncology, McGill University, Montréal, QC, Canada
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Amanda E. Toland
- Department of Internal Medicine, Division of Human Genetics, The Ohio State University, Columbus, OH, USA
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Toon Van Gorp
- Division of Gynecologic Oncology, University Hospital Leuven, Leuven, Belgium
- Leuven Cancer Institute, University of Leuven, Leuven, Belgium
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Digna R. Velez Edwards
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Penelope M. Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Alice S. Whittemore
- Department of Epidemiology & Population Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Anna H. Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Yao Yu
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Argyrios Ziogas
- Department of Epidemiology, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, CA, USA
| | - Andrew Berchuck
- Department of Gynecologic Oncology, Duke University Hospital, Durham, NC, USA
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen L. Goode
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Marc T. Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alvaro N. Monteiro
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth Offit
- Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- AnaNeo Therapeutics, New York, NY, USA
| | - Susan J. Ramus
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW Sydney, Sydney, New South Wales, Australia
- Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, New South Wales, Australia
| | - Harvey A. Risch
- Chronic Disease Epidemiology, Yale School of Medicine, New Haven, CT, USA
| | | | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Clinical Genome Center, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Québec – Université Laval Research Center, Québec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Michelle R. Jones
- Center for Bioinformatics and Functional Genomics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Simon A. Gayther
- Center for Bioinformatics and Functional Genomics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul D.P. Pharoah
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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2
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Binion S, Sorgen LJ, Peshkin BN, Valdimarsdottir H, Isaacs C, Nusbaum R, Graves KD, DeMarco T, Wood M, McKinnon W, Garber J, McCormick S, Ladd MK, Schwartz MD. Telephone versus in-person genetic counseling for hereditary cancer risk: Patient predictors of differential outcomes. J Telemed Telecare 2024; 30:334-343. [PMID: 34779303 PMCID: PMC9902210 DOI: 10.1177/1357633x211052220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Telegenetics has become the predominant mode of cancer genetic counseling during the COVID-19 pandemic. We sought to identify potential patient-level contraindicators for telegenetic genetic counseling. METHODS We analyzed post-counseling (pre-result disclosure) follow-up data from a randomized noninferiority trial of a telephone genetic counseling versus usual care genetic counseling. Among 669 randomized participants, 600 completed pre-test counseling and 568 completed a 2-week follow-up assessment before receiving test results. In this analysis, we focused on genetic counseling outcomes (knowledge, decisional conflict, and distress). In multivariate models controlling for bivariate predictors of these outcomes, we tested our a priori hypotheses that pre-counseling numeracy, perceived stress, and race/ethnicity would moderate the outcomes of telephone genetic counseling versus usual care. RESULTS Only numeracy significantly moderated associations between mode of genetic counseling and outcomes. Higher numeracy was associated with higher post-counseling knowledge following telephone genetic counseling (p < 0.001), but not usual care (p = 0.450). Higher numeracy was also associated with lower distress following telephone genetic counseling (p = 0.009) but not usual care (p = 0.16). Neither perceived stress nor race/ethnicity exhibited differential impacts on telephone genetic counseling versus usual care (ps > 0.20). CONCLUSION Although high numeracy was associated with higher levels of knowledge following telegenetic counseling, we did not identify any clinically significant patient-level contraindicators for telegenetic counseling. These results lend further confidence to the broad use of telegenetics.
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Affiliation(s)
- Savannah Binion
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Lia J. Sorgen
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Beth N. Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Heiddis Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Rachel Nusbaum
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: University of Maryland, School of Medicine, Baltimore, MD
| | - Kristi D. Graves
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Tiffani DeMarco
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA
| | - Marie Wood
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Wendy McKinnon
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
| | - Shelley McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mary K. Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Marc D. Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
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3
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Schwartz MD, Peshkin BN, Isaacs C, Grisham C, Holmes NJ, Sorgen LJ, Collins S, Dawson N, McGuire C, Okobi T, Newell K, Kolla KA, Weinstein V. Pilot Trial of Streamlined Genetic Education and Traceback Genetic Testing in Prostate Cancer Survivors. J Natl Compr Canc Netw 2023; 21:1261-1268.e14. [PMID: 38081141 DOI: 10.6004/jnccn.2023.7071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Germline genetic testing is recommended for men with metastatic or high-risk prostate cancer to inform treatment and risk management for other cancers and inform genetic testing in at-risk relatives. However, relatively few patients with prostate cancer undergo genetic testing. Given the low rate of testing and increasing demands on genetic service providers, strategies are needed that reduce barriers to testing while conserving genetic counseling resources. The primary goal of this study was to determine whether a proactive and streamlined "traceback" approach could yield increased genetic testing participation among prostate cancer survivors. METHODS We randomized 107 survivors of metastatic and high-risk prostate cancer to streamlined testing (ST) versus enhanced usual care (EUC). ST participants were proactively provided with print genetic education materials and the option to proceed to genetic testing without pre-test genetic counseling. EUC participants were sent a letter from their physician advising them of their eligibility for genetic testing and recommending they schedule genetic counseling. The primary outcome was genetic testing participation. Secondary outcomes were distress, knowledge, decision satisfaction, and regret. RESULTS In the ST group, 41.5% of participants completed genetic testing compared with 27.8% in the EUC group. After adjusting for education and marital status, the odds of testing were more than twice as high for the ST group as for the EUC group (odds ratio, 2.57; 95% CI, 1.05-6.29). The groups did not differ on any of the psychosocial outcomes at the 3-month follow-up. CONCLUSIONS Proactive outreach paired with streamlined genetic testing delivery may be a safe, effective, and resource-efficient approach to facilitate traceback genetic testing in prostate cancer survivors.
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Affiliation(s)
- Marc D Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Christopher Grisham
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Nora J Holmes
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Lia J Sorgen
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Sean Collins
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Nancy Dawson
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Colleen McGuire
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Kelsey Newell
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Kavitha A Kolla
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Veronique Weinstein
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
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4
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Tercyak KP, DeMarco TA, Schneider KA, Luta G, Isaacs C, Garber JE, Sleiman MM, Yockel MR, Peshkin BN. Results of a randomized controlled trial of a decision support intervention for disclosing maternal BRCA genetic test results to children and adolescents. PEC Innov 2023; 2:100129. [PMID: 37214493 PMCID: PMC10194096 DOI: 10.1016/j.pecinn.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 05/24/2023]
Abstract
Objective Evaluate the impact of a targeted family communication intervention for mothers undergoing genetic counseling and testing (GCT) for BRCA gene alterations. Methods Following BRCA GCT, mothers (N = 204; M age = 45 y) were randomized to either a control condition (self-help print materials) or intervention (printed decision support guide, based on behavioral decision making theory in health care) for supporting choices about disclosing maternal genetic test results to children and adolescents. Behavioral assessments were administered prior to maternal GCT and after receipt of results: primary outcomes were maternal disclosure to children and parent-child communication quality. Results Mothers in the intervention were > 2x likely to disclose their BRCA test results to their children compared to those in the control condition (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.06, 5.10; p = .04). This effect was moderated by children's ages: mothers of preteens (<13 y) assigned to the intervention were >3x likely to disclose their results (OR = 3.74, 95% CI = 1.49, 9.41; p = .005). In adjusted models, intervention was also associated with favorable changes in the quality of parent-child communication (95% CI = 0.30, 9.00; p < .05). Conclusion Decision support improves parent-child communication outcomes about GCT for hereditary breast-ovarian cancer. Innovation This trial is among the first to empirically evaluate the outcomes of a behavioral intervention to support family communication of maternal BRCA risk information to children.
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Affiliation(s)
- Kenneth P. Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Marcelo M. Sleiman
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Mary Rose Yockel
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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5
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Bhatt M, Peshkin BN, Kazi S, Schwartz MD, Ashai N, Swain SM, Smith DM. Pharmacogenomic testing in oncology: a health system's approach to identify oncology provider perspectives. Pharmacogenomics 2023; 24:859-870. [PMID: 37942634 DOI: 10.2217/pgs-2023-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Aim: Identify oncology healthcare providers' attitudes toward barriers to and use cases for pharmacogenomic (PGx) testing and implications for prescribing anticancer and supportive care medications. Materials & methods: A questionnaire was designed and disseminated to 71 practicing oncology providers across the MedStar Health System. Results: 25 of 70 (36%) eligible oncology providers were included. 88% were aware of PGx testing and 72% believed PGx can improve care. Of providers who had ordered a medication with PGx implications in the past month, interest in PGx for anticancer (90-100%) and supportive care medications (>75%) was high. Providers with previous PGx education were more likely to have ordered a test (odds ratio: 7.9; 95% CI: 1.1-56; p = 0.0394). Conclusion: Oncology provider prescribing practices and interest in PGx suggest opportunities for implementation.
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Affiliation(s)
| | - Beth N Peshkin
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - Sadaf Kazi
- MedStar Health, Columbia, MD 21044, USA
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC 20008, USA
| | - Marc D Schwartz
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - Nadia Ashai
- MedStar Health, Columbia, MD 21044, USA
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
| | - Sandra M Swain
- MedStar Health, Columbia, MD 21044, USA
- Department of Medicine, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
| | - D Max Smith
- MedStar Health, Columbia, MD 21044, USA
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
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6
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Bowen A, Gómez-Trillos S, Curran G, Graves KD, Sheppard VB, Schwartz MD, Peshkin BN, Campos C, Garcés N, Dash C, Aburto L, Valencia-Rojas N, Hernández G, Villa A, Cupertino P, Carrera P, Hurtado-de-Mendoza A. Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community-based organizations. J Genet Couns 2023; 32:965-981. [PMID: 37062905 PMCID: PMC10577152 DOI: 10.1002/jgc4.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.
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Affiliation(s)
| | - Sara Gómez-Trillos
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristi D. Graves
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Marc D. Schwartz
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Beth N. Peshkin
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Nathaly Garcés
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Chiranjeev Dash
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | | | | | - Antonio Villa
- Virginia Commonwealth University, Richmond, Virginia, USA
- La Casa de la Salud, Richmond, Virginia, USA
| | - Paula Cupertino
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
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7
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Hasser E, Peshkin BN, Hamilton JG, Brower J, Ovadia H, Ross LF, Sacca R, Tarini B, Domchek SM, Vittone S, Sleiman M, Isaacs C, Knerr S, Wilfond BS, Tercyak KP. Measuring high-risk parents' opinions about direct-to-consumer genetic testing for adult-onset inherited cancer syndromes in their adolescent and young adult children. J Genet Couns 2023; 32:768-777. [PMID: 36748334 PMCID: PMC10404634 DOI: 10.1002/jgc4.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Neither direct-to-consumer (DTC) genetic testing nor predictive genetic testing for adult-onset conditions is recommended for minor children due to ethical concerns and low clinical utility. However, parents with pathogenic variants (PVs) in disease-causing genes may be interested in pursuing genetic testing that includes the familial PV for their children. The Pediatric Testing Attitudes Scale (P-TAS) was previously developed to examine high-risk parents' opinions about pediatric BRCA genetic testing for adult-onset breast/ovarian cancer. Here, the psychometric properties of the P-TAS were examined in a new sample of N = 126 parents (M age = 47.2 years) with PVs in a more complete set of cancer risk genes represented on DTC panel tests. The mean score on the P-TAS was 44 out of a maximum score of 60, indicating that a majority of parents generally held favorable opinions about testing their children for adult-onset inherited cancer syndromes. The internal consistency of the full scale was high (α = 0.91). A factor analysis identified two-component scales, labeled Attitudes and Beliefs (α = 0.93) and Decision Making and Communication (α = 0.83). In a multivariable regression model, P-TAS co-factors accounted for 34% of variance in parental opinions, including the frequency of prior family communication about cancer and the likelihood of utilizing DTC genetic testing with children (R2 = 0.34, p < 0.001). Results suggest that the P-TAS remains a reliable measure to assess high-risk parents' opinions about pediatric DTC genetic testing for adult-onset conditions, with promising validity. Applications of the P-TAS include informing genetic counseling practice, pediatric medical care, and policy guidelines surrounding DTC genetic testing.
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Affiliation(s)
- Emily Hasser
- University of Washington, Seattle, Washington, USA
| | - Beth N. Peshkin
- Georgetown University, Washington, District of Columbia, USA
| | | | - Jamie Brower
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hannah Ovadia
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Rosalba Sacca
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beth Tarini
- Children's National Health System, Washington, District of Columbia, USA
| | | | - Sarah Vittone
- Georgetown University, Washington, District of Columbia, USA
| | - Marcelo Sleiman
- Georgetown University, Washington, District of Columbia, USA
| | - Claudine Isaacs
- Georgetown University, Washington, District of Columbia, USA
| | - Sarah Knerr
- University of Washington, Seattle, Washington, USA
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8
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Gómez-Trillos S, Graves KD, Fiallos K, Schwartz MD, Peshkin BN, Hamilton H, Sheppard VB, Vadaparampil ST, Campos C, Cupertino AP, Alzamora MC, Lynce F, Hurtado-de-Mendoza A. Cultural adaptations to a telephone genetic counseling protocol and booklet for Latina breast cancer survivors at risk for hereditary breast and ovarian cancer. Transl Behav Med 2023; 13:297-308. [PMID: 36694918 PMCID: PMC10182423 DOI: 10.1093/tbm/ibac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Telephone genetic counseling (TGC) is accepted as standard clinical care for people seeking hereditary cancer risk assessment. TGC has been shown to be non-inferior to in-person genetic counseling, but trials have been conducted with a predominantly highly educated, non-Hispanic White population. This article describes the process of culturally adapting a TGC protocol and visual aid booklet for Spanish-preferring Latina breast cancer survivors at risk for hereditary breast and ovarian cancers. The adaptation process included two phases. Phase 1 involved a review of the literature and recommendations from an expert team including community partners. Phase 2 included interviews and a pilot with the target population (n = 14) to collect feedback about the adapted protocol and booklet following steps from the Learner Verification and Revision Framework. We describe the adaptation process and report the main adaptations following the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME). Adaptations in Phase 1 were responsive to the target population needs and characteristics (e.g., delivered in Spanish at an appropriate health literacy level, addressing knowledge gaps, targeting cultural values). Phase 2 interviews were crucial to refine details (e.g., selecting words) and to add components to address GCT barriers (e.g., saliva sample video). Cultural adaptations to evidence-based TGC protocols can increase the fit and quality of care for historically underserved populations. As TGC visits become routine in clinical care, it is crucial to consider the needs of diverse communities to adequately promote equity and justice in cancer care.
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Affiliation(s)
- Sara Gómez-Trillos
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Katie Fiallos
- Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Heidi Hamilton
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University, VA, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Ana Paula Cupertino
- School of Medicine and Dentistry, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Maria C Alzamora
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
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9
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McDonnell GA, Peshkin BN, DeMarco TA, Peterson SK, Arun BK, Miesfeldt S, O’Neill SC, Schneider K, Garber J, Isaacs C, Luta G, Tercyak KP. Long-Term Adaptation Among Adolescent and Young Adult Children to Familial Cancer Risk. Pediatrics 2022; 150:e2022056339. [PMID: 35859209 PMCID: PMC10646493 DOI: 10.1542/peds.2022-056339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is important to examine adolescent and young adult (AYA) children's long-term psychosocial and behavioral adaptation to disclosure of maternal BRCA-positive carrier status (BRCA+) to inform approaches for familial cancer risk communication, education, and counseling. METHODS Mothers underwent BRCA genetic testing 1 to 5 years earlier. Group differences in AYAs' self-reported outcomes were analyzed by maternal health and carrier status, and child age and sex. RESULTS A total of N = 272 AYAs were enrolled: 76.1% of their mothers were breast or ovarian cancer survivors and 17.3% were BRCA+. AYAs' cancer risk behavior (tobacco and alcohol use, physical activity) and psychologic distress levels did not vary by maternal status. In bivariate analyses, AYAs of cancer-surviving mothers believed themselves to be at greater risk for, and were more knowledgeable about, cancer than AYAs of mothers without cancer. AYAs of BRCA+ mothers were more concerned about cancer, held stronger beliefs about genetic risk, and placed a higher value on learning about genetics. In adjusted models, maternal cancer history (not BRCA+) remained associated with AYAs' greater perceptions of cancer risk (P = .002), and knowledge about cancer (P = .03) and its causes (P = .002). CONCLUSIONS Disclosing maternal BRCA+ status did not influence children's lifestyle behavior or adversely affect quality of life long term. AYAs of BRCA+ mothers were more aware of and interested in genetic risk information. Such families may benefit from support to promote open communication about genetic testing choices.
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Affiliation(s)
- Glynnis A. McDonnell
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | | | | | - Suzanne C. O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Judy Garber
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kenneth P. Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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10
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Kritzik R, Usoro E, Peshkin BN, Isaacs C, Valdimarsdottir HB, Willey S, O’Neill S, DeMarco T, Nusbaum R, Jandorf L, Kelleher S, Schwartz MD. Psychosocial impact of proactive rapid genetic counseling following breast cancer diagnosis. Psychooncology 2022; 31:788-797. [PMID: 34921700 PMCID: PMC9920729 DOI: 10.1002/pon.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE As germline genetic referral becomes increasingly routine as part of the care of newly diagnosed breast cancer patients, it is important to understand the psychosocial impact of genetic counseling at the time of diagnosis. We examined the psychosocial and quality of life (QOL) impact of providing proactive rapid genetic counseling and testing (RGCT) in the immediate aftermath of a breast cancer diagnosis. METHODS We randomized 330 patients in a 2:1 ratio to proactive rapid genetic counseling (RGCT; N = 222) versus usual care (UC; N = 108). Participants completed a baseline telephone survey before randomization and definitive surgery and a follow-up survey at 1-month post-randomization. We evaluated the impact of RGCT versus UC on breast cancer genetic knowledge, distress, QOL, and decisional conflict. Given that 43% of UC participants and 86% of RGCT participants completed genetic counseling prior to the 1-month assessment, we also evaluated the impact of genetic counseling participation over and above group assignment. RESULTS The RGCT intervention led to increased breast cancer genetic knowledge relative to UC but did not differentially impact other study outcomes. Across groups patients who participated in genetic counseling had significantly increased knowledge and improved QOL compared to those who did not participate in genetic counseling. CONCLUSIONS While prior research has documented the impact of genetic counseling and testing on surgical decisions, these results confirm that participation in genetic counseling at the time of diagnosis can yield improvements in knowledge and QOL in the short-term.
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Affiliation(s)
- Rachel Kritzik
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Edidiong Usoro
- Department of Biology, University of the District of Columbia, Washington, DC, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Heiddis B. Valdimarsdottir
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shawna Willey
- Breast Cancer Program, Schar Cancer Institute, INOVA Health System, Fairfax, VA, USA
| | - Suzanne O’Neill
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Tiffani DeMarco
- Cancer Genetics Program, INOVA Health System, Fairfax, VA, USA
| | - Rachel Nusbaum
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
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11
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Hardy MW, Peshkin BN, Rose E, Ladd MK, Binion S, Tynan M, McBride CM, Grinzaid KA, Schwartz MD. Attitudes and interest in incorporating BRCA1/2 cancer susceptibility testing into reproductive carrier screening for Ashkenazi Jewish men and women. J Community Genet 2022; 13:281-292. [PMID: 35486291 PMCID: PMC9051789 DOI: 10.1007/s12687-022-00590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/19/2022] [Indexed: 10/31/2022] Open
Abstract
Pathogenic variants in the BRCA1 and BRCA2 (BRCA1/2) genes are associated with elevated cancer risks in men and women. Due to a founder effect, Ashkenazi Jewish individuals are at higher risk for carrying three specific BRCA1/2 pathogenic variants. There have been recent calls for population screening in this population because many carriers do not have family histories suggestive of hereditary cancer. One approach could be to integrate optional BRCA1/2 testing into routinely offered reproductive carrier screening for recessive and X-linked disorders. However, the differing goals of these types of testing (i.e., personal health risks versus family planning) raise questions about the implications for patient education and informed consent. To this end, we aimed to determine interest, attitudes, and preferences regarding integrating such testing by electronically surveying 331 Ashkenazi Jewish participants in JScreen - a national, not-for-profit, at-home carrier screening program focused on genetic risks in Jewish communities. We found that while 41% of participants had plans to pursue BRCA1/2 testing, 93% would have opted for such testing if offered as an add-on to reproductive carrier screening. This was particularly true of those with higher perceived cancer risk and more positive attitudes toward genetic testing. With respect to preferences about delivery of this service, more than 85% of participants preferred remote (telephone, print, or web-based) genetic education rather than traditional genetic counseling. These results suggest that offering optional BRCA1/2 testing within the context of reproductive carrier screening might provide opportunities for cancer prevention without overburdening scarce genetic counseling resources.
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Affiliation(s)
- Melanie W Hardy
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, 2115 Wisconsin Avenue, Suite 300, Washington, DC, 20007, USA
| | - Esther Rose
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary Kathleen Ladd
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, 2115 Wisconsin Avenue, Suite 300, Washington, DC, 20007, USA
| | - Savannah Binion
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, 2115 Wisconsin Avenue, Suite 300, Washington, DC, 20007, USA
| | - Mara Tynan
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, 2115 Wisconsin Avenue, Suite 300, Washington, DC, 20007, USA
| | - Colleen M McBride
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Karen A Grinzaid
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, 2115 Wisconsin Avenue, Suite 300, Washington, DC, 20007, USA.
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12
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Lee AJ, Hui AC, Walker AD, Peshkin BN, Swain SM, Smith DM. Evaluation of a longitudinal pharmacogenomics education on pharmacist knowledge in a multicampus healthcare system. Pharmacogenomics 2022; 23:173-182. [PMID: 35042388 DOI: 10.2217/pgs-2021-0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: To evaluate the effect of pharmacogenomics (PGx) education for pharmacists. Materials & Methods: Three-part weekly webinar series occurred in 2021. Pharmacists were assessed on their PGx knowledge at baseline and after each webinar. The primary end point was a change in the percent of correct responses between the baseline and week 1 assessment. Secondary end points included change in knowledge at weeks 4-8 and change in self-efficacy. Results: In total, 19 of 58 participants were eligible for the primary analysis, which showed an average improvement of 37% (p < 0.0001). Knowledge remained consistent between week 1 and weeks 4-8. Average self-efficacy increased (p < 0.0001) and was maintained at weeks 4-8. Conclusion: The PGx webinar series resulted in a lasting improvement in PGx knowledge and self-efficacy.
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Affiliation(s)
- Andrew J Lee
- Department of Pharmacy, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Adrian C Hui
- Department of Pharmacy, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | | | - Beth N Peshkin
- Georgetown University Medical Center, Washington, DC 20057, USA
| | - Sandra M Swain
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
| | - D Max Smith
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
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13
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Marshall JL, Peshkin BN, Yoshino T, Vowinckel J, Danielsen HE, Melino G, Tsamardinos I, Haudenschild C, Kerr DJ, Sampaio C, Rha SY, FitzGerald KT, Holland EC, Gallagher D, Garcia-Foncillas J, Juhl H. OUP accepted manuscript. Oncologist 2022; 27:272-284. [PMID: 35380712 PMCID: PMC8982374 DOI: 10.1093/oncolo/oyab048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- John L Marshall
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Corresponding author: John L. Marshall, MD, The Ruesch Center for the Cure of Gastrointestinal Cancers, Frederick P. Smith Endowed Chair, Chief, Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC 20007, USA. Tel: +1 202 444 2223;
| | - Beth N Peshkin
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | | | - Håvard E Danielsen
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radiumhospitalet, Montebello, Oslo, Norway
| | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Ioannis Tsamardinos
- JADBio Gnosis DA, N. Plastira 100, Science and Technology Park of Crete and Institute of Applied and Computational Mathematics, Foundation for Research and Technology Hellas, Heraklion, GR, Greece
| | | | - David J Kerr
- Nuffield Division of Clinical and Laboratory Sciences, Level 4, Academic Block, John Radcliffe Infirmary, Headington, Oxford, UK
| | | | - Sun Young Rha
- Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-Ku, Seoul, Korea
| | - Kevin T FitzGerald
- Department of Medical Humanities in the School of Medicine, Creighton University, Omaha, NE, USA
| | - Eric C Holland
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Gallagher
- St. James’s Hospital/Trinity College Dublin, St. Raphael’s House, Dublin, Ireland
| | - Jesus Garcia-Foncillas
- Cancer Institute, Fundacion Jimenez Diaz University Hospital, Autonomous University, Madrid, Spain
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14
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O'Neill SC, Hamilton JG, Conley CC, Peshkin BN, Sacca R, McDonnell GA, Isaacs C, Robson ME, Tercyak KP. Improving our model of cascade testing for hereditary cancer risk by leveraging patient peer support: a concept report. Hered Cancer Clin Pract 2021; 19:40. [PMID: 34565430 PMCID: PMC8474818 DOI: 10.1186/s13053-021-00198-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Consensus and evidence suggest that cascade testing is critical to achieve the promise of cancer genetic testing. However, barriers to cascade testing include effective family communication of genetic risk information and family members' ability to cope with genetic risk. These barriers are further complicated by the developmental needs of unaffected family members during critical windows for family communication and adaptation. Peer support could address these barriers. We provide two illustrative examples of ongoing BRCA1/2-related clinical trials that apply a peer support model to improve family communication and functioning. Peer support can augment currently available genetic services to facilitate adjustment to and effective use of cancer genetic risk information. Importantly, this scalable approach can address the presence of cancer risk within families across multiple developmental stages. This applies a family-centered perspective that accommodates all potentially at-risk relatives. This peer support model can be further applied to emerging topics in clinical genetics to expand reach and impact.
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Affiliation(s)
- Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA.
| | | | - Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Rosalba Sacca
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kenneth P Tercyak
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
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15
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Vadaparampil ST, Moreno Botero L, Fuzzell L, Garcia J, Jandorf L, Hurtado-de-Mendoza A, Campos-Galvan C, Peshkin BN, Schwartz MD, Lopez K, Ricker C, Fiallos K, Quinn GP, Graves KD. Development and pilot testing of a training for bilingual community education professionals about hereditary breast and ovarian cancer among Latinas: ÁRBOLES Familiares. Transl Behav Med 2021; 12:6320107. [PMID: 34255089 DOI: 10.1093/tbm/ibab093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cancer health disparities remain a significant problem in the USA, compounded by lack of access to care, language barriers and systemic biases in health care. These disparities are particularly evident in areas such as genetics/genomics. For example, Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have extremely low rates of genetic counseling/testing. Long-standing barriers and inequities in access to services such as genetic counseling and testing require innovative solutions. One solution can involve training community outreach and education professionals (CORE-Ps) to bridge the gap between underserved communities and genetic specialists. We sought to develop and pilot test a training program for English-Spanish bilingual CORE-Ps to reduce disparities in access to and uptake of genetic services among Latino populations. Guided by Adult Learning Theory and with input from multiple stakeholders, we developed ÁRBOLES Familiares (Family Trees), an in-person and online training program for bilingual CORE-Ps to facilitate identification, referral, and navigation of Latinas to genetic counseling/testing. We conducted a pilot test of 24 CORE-Ps recruited from across the United States and assessed knowledge, genetic literacy, and self-efficacy at baseline and follow-up. At follow-up, participants in the pilot with complete baseline and follow-up data (N = 15) demonstrated significant improvements in HBOC knowledge, genetic literacy, self-efficacy and reports of fewer barriers to identify/navigate Latinas (ps < .05). Qualitative assessment identified ways to improve the training curriculum. Pilot results suggest ÁRBOLES is a promising approach for training CORE-Ps to identify and refer high-risk Latinas to genetic services. Next steps involve further refinement of ÁRBOLES, development of an online toolkit, and adaptation for virtual delivery.
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Affiliation(s)
- Susan T Vadaparampil
- Moffitt Cancer Center, Tampa, FL, USA.,Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
| | | | | | | | - Lina Jandorf
- Icahn School of Medicine, Department of Population Health Science and Policy, New York, NY, USA
| | - Alejandra Hurtado-de-Mendoza
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Beth N Peshkin
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Marc D Schwartz
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Katherine Lopez
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Charité Ricker
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Katie Fiallos
- Johns Hopkins University Kimmel Cancer Center, Baltimore, MD, USA
| | | | - Kristi D Graves
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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16
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Peshkin BN, Ladd MK, Isaacs C, Segal H, Jacobs A, Taylor KL, Graves KD, O'Neill SC, Schwartz MD. The Genetic Education for Men (GEM) Trial: Development of Web-Based Education for Untested Men in BRCA1/2-Positive Families. J Cancer Educ 2021; 36:72-84. [PMID: 31402434 PMCID: PMC7010546 DOI: 10.1007/s13187-019-01599-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cascade testing for hereditary breast/ovarian cancer is an important public health priority. Increasing attention has been paid to the relevance of testing for men within BRCA1/2-positive families given that such testing may provide important information about their cancer risks, particularly for prostate cancer, and risks to their offspring. However, men are much less likely to seek genetic counseling and testing than their at-risk female relatives. To facilitate access to pre-test information and testing, we developed a web-based intervention (WI) for men that we are evaluating in a pilot randomized controlled trial (RCT). This paper describes three phases of research in the development of the WI: (1) formative (qualitative) research among men from BRCA1/2 families to assess needs and preferences for education; (2) a detailed description of the organization, format, and content of the WI; and (3) usability testing. We discuss the aims and hypotheses of the pilot RCT in which the WI is being compared with an enhanced usual care condition among at-risk men. We expect that the WI described here will foster informed decisions and lead to increased use of BRCA1/2 counseling and testing, potentially yielding improved cancer control outcomes for this understudied group, and for their at-risk relatives.
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Affiliation(s)
- Beth N Peshkin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Mary Kate Ladd
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Hannah Segal
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Aryana Jacobs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Kathryn L Taylor
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Suzanne C O'Neill
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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17
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Hurtado-de-Mendoza A, Gómez-Trillos S, Graves KD, Carrera P, Campos C, Anderson L, Gronda A, Orellana H, Peshkin BN, Schwartz MD, Cupertino P, Ostrove N, Luta G, Gonzalez N, Sheppard VB. Process evaluation of a culturally targeted video for Latinas at risk of hereditary breast and ovarian cancer. J Genet Couns 2020; 30:730-741. [PMID: 33222313 DOI: 10.1002/jgc4.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
This paper presents a process evaluation of a culturally targeted narrative video about hereditary breast and ovarian cancer (HBOC) for Latina women at risk for HBOC. Spanish-speaking Latina women at risk for HBOC participated in a single arm study (n = 40). Participants watched the video developed by the authors and responded to surveys. We used mixed methods to assess theoretical constructs that are hypothesized mediators of narrative interventions (i.e., transportation or engagement, identification with characters, emotions) and implementation outcomes (e.g., acceptability). Descriptive statistics summarized theoretical constructs and implementation outcomes. We conducted Mann-Whitney U tests to assess the differences in theoretical and implementation outcomes between participants who were affected versus. unaffected and participants with different levels of education and health literacy. We used the consensual qualitative research framework to analyze qualitative data. Participants' mean age was 47.1 years (SD = 9.48). Most participants were high school graduates or less (62.5%). Acceptability of the video was extremely high (Md = 10.0, IQR = 0.2, scale 1-10). Most (82.5%) suggested video dissemination be through social media. Participants were highly engaged (Md = 5.7, IQR = 1.5, scale 1-7), strongly identified with the main character (Md = 8.7, IQR = 2.6, scale 1-10), and reported experiencing mostly positive emotions (Md = 9.5, IQR = 2.8, scale 1-10). Participants with low health literacy and affected participants reported a significantly higher identification with the main character (p<.05). Qualitative data reinforced the quantitative findings. Women reported gaining knowledge, correcting misconceptions, and feeling empowered. Our culturally targeted video is highly acceptable and targets mechanisms of behavior change for narrative interventions. The video is easily disseminable and can be used as an education tool for patients including affected and unaffected women and patients with different education and health literacy levels. Future studies should test the impact of the video in enhancing genetic counseling and testing uptake.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lyndsay Anderson
- School of Nursing, College of Health and Human Services, California State University, Sacramento, CA, USA
| | - Andrés Gronda
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Halyn Orellana
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - George Luta
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA, USA
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18
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Lynce F, Schlam I, Geng X, Peshkin BN, Friedman S, Dutil J, Nahleh Z, Campos C, Ricker C, Rodriguez P, Denduluri N, Ahn J, Isaacs C, Graves KD. BRCA1/2 mutations and risk-reducing bilateral salpingo-oophorectomy among Latinas: The UPTAKE study. J Genet Couns 2020; 30:383-393. [PMID: 33010199 PMCID: PMC10064975 DOI: 10.1002/jgc4.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Abstract
Bilateral salpingo-oophorectomy (BSO) is a risk management approach with strong evidence of mortality reduction for women with germline mutations in the tumor suppressor genes BRCA1 and BRCA2 (BRCA1/2). Few studies to date have evaluated uptake of BSO in women from diverse racial and ethnic backgrounds who carry BRCA1/2 mutations. The objective of the UPTAKE study was to explore rates and predictors of risk-reducing BSO among Latinas affected and unaffected with breast cancer who had a deleterious BRCA1/2 mutation. We recruited 100 Latina women with deleterious BRCA1/2 mutations from community hospitals, academic health systems, community, and advocacy organizations. Women completed interviews in Spanish or English. We obtained copies of genetic test reports for participants who provided signed medical release. After performing threefold cross-validation LASSO for variable selection, we used multiple logistic regression to identify demographic and clinical predictors of BSO. Among 100 participants, 68 had undergone BSO at the time of interview. Of these 68, 35 were US-born (61% of all US-born participants) and 33 were not (77% of the non-US-born participants). Among Latinas with BRCA1/2 mutations, older age (p = 0.004), personal history of breast cancer (p = 0.003), higher income (p = 0.002), and not having a full-time job (p = 0.027) were identified as variables significantly associated with uptake of BSO. Results suggest a high rate of uptake of risk-reducing BSO among a sample of Latinas with BRCA1/2 mutations living in the US. We document factors associated with BSO uptake in a diverse sample of women. Relevant to genetic counseling, our findings identify possible targets for supporting Latinas' decision-making about BSO following receipt of a positive BRCA1/2 test.
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Affiliation(s)
- Filipa Lynce
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ilana Schlam
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Sue Friedman
- Force - Facing Our Risk of Cancer Empowered, Tampa, FL, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | | | | | - Charité Ricker
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Patricia Rodriguez
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Neelima Denduluri
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
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19
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Smith DM, Namvar T, Brown RP, Springfield TB, Peshkin BN, Walsh RJ, Welsh JC, Levin B, Brandt N, Swain SM. Assessment of primary care practitioners' attitudes and interest in pharmacogenomic testing. Pharmacogenomics 2020; 21:1085-1094. [PMID: 32969759 DOI: 10.2217/pgs-2020-0064] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnaire was designed and then disseminated to PCPs across the MedStar Health System. Results: Ninety of 312 (29%) PCPs responded and were included in analyses. Seventy-six (84%) had heard of PGx and 12 (13%) previously ordered PGx testing. Most, 68 (76%), believed PGx can improve care; however, a minority, 23 (26%), reported confidence in using PGx in prescribing decisions. Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx for antidepressants (75%), proton pump inhibitors (72%) and other medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.
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Affiliation(s)
- D Max Smith
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
| | - Tarlan Namvar
- University of Maryland School of Pharmacy, Lamy Center, MD 212014, USA
| | | | | | - Beth N Peshkin
- Georgetown University Medical Center, Washington, DC 20057, USA
| | | | | | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Lamy Center, MD 212014, USA.,MedStar Center for Successful Aging, Baltimore, MD 21239, USA
| | - Sandra M Swain
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
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20
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Ladd MK, Peshkin BN, Senter L, Baldinger S, Isaacs C, Segal H, Philip S, Phillips C, Shane K, Martin A, Weinstein V, Pilarski R, Jeter J, Sweet K, Hatten B, Wurtmann EJ, Phippen S, Bro D, Schwartz MD. Predictors of risk-reducing surgery intentions following genetic counseling for hereditary breast and ovarian cancer. Transl Behav Med 2020; 10:337-346. [PMID: 30418620 DOI: 10.1093/tbm/iby101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) are increasingly used to reduce breast and ovarian cancer risk following BRCA1/BRCA2 testing. However, little is known about how genetic counseling influences decisions about these surgeries. Although previous studies have examined intentions prior to counseling, few have examined RRM and RRSO intentions in the critical window between genetic counseling and test result disclosure. Previous research has indicated that intentions at this time point predict subsequent uptake of surgery, suggesting that much decision-making has taken place prior to result disclosure. This period may be a critical time to better understand the drivers of prophylactic surgery intentions. The aim of this study was to examine predictors of RRM and RRSO intentions. We hypothesized that variables from the Health Belief Model would predict intentions, and we also examined the role of affective factors. Participants were 187 women, age 21-75, who received genetic counseling for hereditary breast and ovarian cancer. We utilized multiple logistic regression to identify independent predictors of intentions. 49.2% and 61.3% of participants reported intentions for RRM and RRSO, respectively. Variables associated with RRM intentions include: newly diagnosed with breast cancer (OR = 3.63, 95% CI = 1.20-11.04), perceived breast cancer risk (OR = 1.46, 95% CI = 1.17-1.81), perceived pros (OR = 1.79, 95% CI = 1.38-2.32) and cons of RRM (OR = 0.81, 95% CI = 0.65-0.996), and decision conflict (OR = 0.80, 95% CI = 0.66-0.98). Variables associated with RRSO intentions include: proband status (OR = 0.28, 95% CI = 0.09-0.89), perceived pros (OR = 1.35, 95% CI = 1.11-1.63) and cons of RRSO (OR = 0.72, 95% CI = 0.59-0.89), and ambiguity aversion (OR = 0.79, 95% CI = 0.65-0.95). These data provide support for the role of genetic counseling in fostering informed decisions about risk management, and suggest that the role of uncertainty should be explored further.
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Affiliation(s)
- Mary Kathleen Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Shari Baldinger
- Virgina Piper Cancer Institute, Allina Health, Minneapolis, MN
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Hannah Segal
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Samantha Philip
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Chloe Phillips
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Kate Shane
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Aimee Martin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Veronique Weinstein
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Joanne Jeter
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Kevin Sweet
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Bonnie Hatten
- Virgina Piper Cancer Institute, Allina Health, Minneapolis, MN
| | | | - Shanda Phippen
- Virgina Piper Cancer Institute, Allina Health, Minneapolis, MN
| | - Della Bro
- Virgina Piper Cancer Institute, Allina Health, Minneapolis, MN
| | - Marc D Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
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21
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Ladd MK, Peshkin BN, Isaacs C, Hooker G, Willey S, Valdimarsdottir H, DeMarco T, O'Neill S, Binion S, Schwartz MD. Predictors of genetic testing uptake in newly diagnosed breast cancer patients. J Surg Oncol 2020; 122:134-143. [PMID: 32346886 DOI: 10.1002/jso.25956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Many newly diagnosed breast cancer patients do not receive genetic counseling and testing at the time of diagnosis. We examined predictors of genetic testing (GT) in this population. METHODS Within a randomized controlled trial of proactive rapid genetic counseling and testing vs usual care, patients completed a baseline survey within 6 weeks of breast cancer diagnosis but before a definitive survey. We conducted a multinomial logistic regression to identify predictors of GT timing/uptake. RESULTS Having discussed GT with a surgeon was a dominant predictor (χ2 (2, N = 320) = 70.13; P < .0001). Among those who discussed GT with a surgeon, patients who had made a final surgery decision were less likely to receive GT before surgery compared with postsurgically (OR [odds ratio] = 0.24; 95% confidence interval [CI] = 0.12-0.49) or no testing (OR = 0.28; 95% CI = 0.14-0.56). Older patients (OR = 0.95; 95% CI = 0.91-0.99) and participants enrolled in New York/New Jersey (OR = 0.22; 95% CI = 0.07-0.72) were less likely to be tested compared with receiving results before surgery. Those with higher perceived risk (OR = 1.02; 95% CI = 1.00-1.03) were more likely to receive results before surgery than to not be tested. CONCLUSIONS This study highlights the role of patient-physician communication about GT as well as patient-level factors that predict presurgical GT.
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Affiliation(s)
- Mary K Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Gillian Hooker
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Shawna Willey
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Heiddis Valdimarsdottir
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tiffani DeMarco
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Suzanne O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Savannah Binion
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Marc D Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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22
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Smith DM, Peshkin BN, Springfield TB, Brown RP, Hwang E, Kmiecik S, Shapiro R, Eldadah Z, Lundergan C, McAlduff J, Levin B, Swain SM. Pharmacogenetics in Practice: Estimating the Clinical Actionability of Pharmacogenetic Testing in Perioperative and Ambulatory Settings. Clin Transl Sci 2020; 13:618-627. [PMID: 31961467 PMCID: PMC7214646 DOI: 10.1111/cts.12748] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/17/2019] [Indexed: 01/04/2023] Open
Abstract
Most literature describing pharmacogenetic implementations are within academic medical centers and use single‐gene tests. Our objective was to describe the results and lessons learned from a multisite pharmacogenetic pilot that utilized panel‐based testing in academic and nonacademic settings. This was a retrospective analysis of 667 patients from a pilot in 4 perioperative and 5 outpatient cardiology clinics. Recommendations related to 12 genes and 65 drugs were classified as actionable or not actionable. They were ascertained from Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and US Food and Drug Administration (FDA) labeling. Patients displayed a high prevalence of actionable results (88%, 99%) and use of medications (28%, 46%) with FDA or CPIC recommendations, respectively. Sixteen percent of patients had an actionable result for a current medication per CPIC compared with 5% per FDA labeling. A systematic approach by a health system may be beneficial given the quantity and diversity of patients affected.
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Affiliation(s)
- D Max Smith
- MedStar Health, Columbia, Maryland, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - Beth N Peshkin
- Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | | | | | - Zayd Eldadah
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Conor Lundergan
- MedStar Cardiology Associates, LLC, Leonardtown, Maryland, USA
| | | | | | - Sandra M Swain
- MedStar Health, Columbia, Maryland, USA.,Georgetown University Medical Center, Washington, DC, USA
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23
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Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Carrera P, Campos C, Anderson L, Luta G, Peshkin BN, Schwartz MD, Cupertino AP, Gonzalez N, Sheppard VB. Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer. Int J Environ Res Public Health 2019; 16:E4793. [PMID: 31795362 PMCID: PMC6926842 DOI: 10.3390/ijerph16234793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022]
Abstract
Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Claudia Campos
- Nueva Vida, DC Office—801 N Pitt St., Suite 113, Alexandria, VA 22314, USA;
| | - Lyndsay Anderson
- College of Health and Human Services, School of Nursing, California State University, Sacramento, CA 95819, USA;
| | - George Luta
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Department of Biostatistics, Bioinformatics and Biomathematics, 4000 Reservoir Rd., NW, Washington, DC 20057, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, 40 Prospect Avenue, Office number 316, Hackensack, NJ 07601, USA;
| | - Nathaly Gonzalez
- Capital Breast Care Center, 1000 New Jersey Ave, SE, Washington, DC 20003, USA;
| | - Vanessa B. Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Massey Cancer Center, Office of Health Equity and Disparities Research, Richmond, VA 23298, USA
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24
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Grady MC, Kolla KA, Peshkin BN. Multigene Cancer Panels: Implications for Pre- and Post-test Genetic Counseling. Curr Genet Med Rep 2019. [DOI: 10.1007/s40142-019-00173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Peshkin BN, Isaacs C, Schwartz MD. Re: Cascade Genetic Testing of Relatives for Hereditary Cancer Risk: Results of an Online Initiative. J Natl Cancer Inst 2019; 111:872-873. [DOI: 10.1093/jnci/djz028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Beth N Peshkin
- See the Notes section for the full list of authors’ affiliations
| | - Claudine Isaacs
- See the Notes section for the full list of authors’ affiliations
| | - Marc D Schwartz
- See the Notes section for the full list of authors’ affiliations
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26
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Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Song M, Anderson L, Campos C, Carrera P, Ostrove N, Peshkin BN, Schwartz MD, Ficca N, Cupertino AP, Gonzalez N, Otero A, Huerta E, Sheppard VB. Developing a culturally targeted video to enhance the use of genetic counseling in Latina women at increased risk for hereditary breast and ovarian cancer. J Community Genet 2019; 11:85-99. [PMID: 31104207 DOI: 10.1007/s12687-019-00423-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/25/2019] [Indexed: 01/28/2023] Open
Abstract
Disparities for genetic cancer risk assessment (GCRA) for hereditary breast and ovarian cancer (HBOC) persist between Latina and non-Hispanic Whites. There are few tested culturally targeted interventions. We developed a culturally targeted video to enhance GCRA uptake in at-risk Latinas. Interviews with healthcare providers (n = 20) and at-risk Latinas (n = 20) were conducted as formative research to inform the development of the video. Findings from the formative research, health behavior conceptual models, and evidence-based risk communication strategies informed the messages for the script. Then, we conducted a focus group with at-risk Latinas (n = 7) to obtain feedback for final refinement of the script. The final video was piloted for acceptability and potential dissemination in a sample of Latino community health workers (CHWs) (n = 31). Providers and at-risk Latinas suggested using simple language and visual aids to facilitate comprehension. Participants in the focus group identified areas for further clarification (e.g., cost). The result was an 18-min video that illustrates "Rosa's" story. Rosa learns about HBOC risk factors and overcomes barriers to attend genetic counseling. CHWs reported high overall satisfaction with the video (M = 9.61, SD = .88, range 1-10). A culturally targeted video has the potential to reach underserved populations with low literacy and English proficiency.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA. .,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA.
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Minna Song
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA
| | - Lyndsay Anderson
- Department of Nursing, California State University, Sacramento, USA
| | - Claudia Campos
- Nueva Vida, DC Office-Alexandria, 206 N. Washington St. Suite 300, Alexandria, VA, 22314, USA
| | - Pilar Carrera
- Department of Psychology, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Nan Ficca
- National Conservatory of Dramatic Arts, Washington, DC, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nathaly Gonzalez
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Capital Breast Cancer Center, 1000 New Jersey Ave, SE, Washington, DC, USA
| | - Andrea Otero
- Instituto de Medicina Oncológica y Molecular de Asturias (IMOMA), Av. Richard Grandío, 33193, Oviedo (Asturias), Spain
| | - Elmer Huerta
- Cancer Preventorium, Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving St, NW, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA, USA
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27
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Tercyak KP, Bronheim SM, Kahn N, Robertson HA, Anthony BJ, Mays D, O’Neill SC, Peterson SK, Miesfeldt S, Peshkin BN, DeMarco TA. Cancer genetic health communication in families tested for hereditary breast/ovarian cancer risk: a qualitative investigation of impact on children's genetic health literacy and psychosocial adjustment. Transl Behav Med 2019; 9:493-503. [PMID: 31094441 PMCID: PMC6520800 DOI: 10.1093/tbm/ibz012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children's literacy about the genetics of late-onset hereditary breast/ovarian cancer (HBOC) often develops through conversations with parents about BRCA gene testing and adults' cancer diagnoses. These conversations may promote early understanding of HBOC, but the long-term impact on children's psychosocial adjustment remains unclear. We investigated cancer genetic health communication in BRCA-tested families to consider benefits, risks, and moderating influences on children's understanding and well-being. Adolescent and young adult children (ages 12-24) of mothers who underwent BRCA testing 1+ years previously completed qualitative interviews that were transcribed, coded (intercoder K ≥ .70), and content-analyzed (N = 34). Children readily recalled conversations about BRCA testing and HBOC (100%) that they considered important (94%), but implications for children were ambiguous and obfuscated their concerns. Psychosocial impacts were muted, multifaceted, and displayed a range of favorable (82%), neutral (71%), and unfavorable (59%) response-frequently co-occurring within the same child over different aspects (e.g., medical, concern for self and others). Children verbalized active (50%) and avoidant (38%) coping strategies: about 1:5 endorsed transient thoughts about vulnerability to HBOC, 1:3 had not further considered it, and all reported specific actions they had or would undertake to remain healthy (e.g., diet/exercise). A majority (94%) of children had or would consider genetic testing for themselves, usually later in life (59%). Long-term outcomes highlighted benefits (awareness of HBOC, psychological hardiness, healthier lifestyle behaviors), as well as some psychosocial concerns that could be managed through interventions promoting genetic health literacy.
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Affiliation(s)
- Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne M Bronheim
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Nicole Kahn
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Hillary A Robertson
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Bruno J Anthony
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne C O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Susan K Peterson
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Miesfeldt
- Scarborough Campus, Maine Medical Center Cancer Institute, Scarborough, ME, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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O'Neill SC, Evans C, Hamilton RJ, Peshkin BN, Isaacs C, Friedman S, Tercyak KP. Information and support needs of young women regarding breast cancer risk and genetic testing: adapting effective interventions for a novel population. Fam Cancer 2019; 17:351-360. [PMID: 29124494 DOI: 10.1007/s10689-017-0059-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Young women from hereditary breast and ovarian cancer (HBOC) families face a unique set of challenges in managing their HBOC risk, where obtaining essential information to inform decision making is key. Previous work suggests that this need for specific health information also comes at a time of heightened distress and greater individuation from family. In this report, we describe our adaptation of a previously-studied behavioral intervention for this population, utilizing a systematic approach outlined by the Centers for Disease Control and Prevention. First, we assessed the information needs and levels of distress in this population and correlates of this distress. These data then were used to inform the adaptation and piloting of a three-session telephone-based peer coaching intervention. One hundred young women (M age = 25 years) who were first or second degree relatives of BRCA1/2 mutation carriers participated. Sixty-three percent of the sample endorsed unmet HBOC information needs and they, on average, reported moderate levels of cancer-related distress (M = 21.9, SD = 14.6). Greater familial disruption was associated with greater cancer-related distress in multivariable models (p < .05). Ten women who participated in the survey completed the intervention pilot. They reported lower distress from pre- to post- (15.8 vs. 12.0), as well as significantly lower decisional conflict (p < .05) and greater endorsement of an array of healthy coping strategies (i.e., active coping, instrumental coping, positive reframing, planning, p's < .05). Our survey results suggest that young adult women from HBOC families have unmet cancer genetic information and support needs. Our pilot intervention was able to reduce levels of decisional conflict and promote the use of effective coping strategies. This approach needs to be further tested in a larger randomized trial.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Rebekah J Hamilton
- Armour Academic Center, College of Nursing, Rush University, 600 S. Paulina Street, Suite 1080, Chicago, IL, 60612, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC, 20007, USA
| | - Sue Friedman
- FORCE, Inc., 16057 Tampa Palms Blvd. W, PMB #373, Tampa, FL, 33647, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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29
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Walker LC, Marquart L, Pearson JF, Wiggins GAR, O'Mara TA, Parsons MT, Barrowdale D, McGuffog L, Dennis J, Benitez J, Slavin TP, Radice P, Frost D, Godwin AK, Meindl A, Schmutzler RK, Isaacs C, Peshkin BN, Caldes T, Hogervorst FBL, Lazaro C, Jakubowska A, Montagna M, Chen X, Offit K, Hulick PJ, Andrulis IL, Lindblom A, Nussbaum RL, Nathanson KL, Chenevix-Trench G, Antoniou AC, Couch FJ, Spurdle AB. Correction: Evaluation of copy-number variants as modifiers of breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. Eur J Hum Genet 2019; 27:167-168. [PMID: 30135485 PMCID: PMC6303246 DOI: 10.1038/s41431-018-0216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This Article was originally published under a CC BY-NC-SA 4.0 license, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the Article have been modified accordingly.
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Affiliation(s)
- Logan C Walker
- Department of Pathology, University of Otago, Christchurch, New Zealand.
| | - Louise Marquart
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John F Pearson
- Biostatistics and Computational Biology Unit, Department of the Dean, University of Otago, Christchurch, New Zealand
| | | | - Tracy A O'Mara
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Michael T Parsons
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Daniel Barrowdale
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Lesley McGuffog
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Joe Dennis
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Javier Benitez
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - Thomas P Slavin
- Department of Population Sciences Division of Clinical Cancer Genomics, City of Hope Clinical Cancer Genomics Community Research Network, Duarte, CA, USA
| | - Paolo Radice
- Department of Preventive and Predictive Medicine, Unit of Molecular Bases of Genetic Risk and Genetic Testing, Fondazione IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Debra Frost
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alfons Meindl
- Department of Gynaecology and Obstetrics, Division of Tumor Genetics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rita Katharina Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, USA
| | - Trinidad Caldes
- Molecular Oncology Laboratory CIBERONC, Hospital Clinico San Carlos, IdISSC (El Instituto de Investigación Sanitaria del Hospital Clínico San Carlos), Madrid, Spain
| | | | - Conxi Lazaro
- Molecular Diagnostic Unit, Hereditary Cancer Program, IDIBELL (Bellvitge Biomedical Research Institute), Catalan Institute of Oncology, Gran Via de l'Hospitalet, Barcelona, Spain
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Xiaoqing Chen
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kenneth Offit
- Department of Medicine, Cancer Biology and Genetics, Clinical Genetics Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Robert L Nussbaum
- Department of Medicine and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Katherine L Nathanson
- Department of Medicine and the Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Georgia Chenevix-Trench
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Amanda B Spurdle
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Schwartz MD, Peshkin BN, Isaacs C, Willey S, Valdimarsdottir HB, Nusbaum R, Hooker G, O'Neill S, Jandorf L, Kelly SP, Heinzmann J, Zidell A, Khoury K. Randomized trial of proactive rapid genetic counseling versus usual care for newly diagnosed breast cancer patients. Breast Cancer Res Treat 2018; 170:517-524. [PMID: 29611029 PMCID: PMC6026034 DOI: 10.1007/s10549-018-4773-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Breast cancer patients who carry BRCA1/BRCA2 gene mutations may consider bilateral mastectomy. Having bilateral mastectomy at the time of diagnosis not only reduces risk of a contralateral breast cancer, but can eliminate the need for radiation therapy and yield improved reconstruction options. However, most patients do not receive genetic counseling or testing at the time of their diagnosis. In this trial, we tested proactive rapid genetic counseling and testing (RGCT) in newly diagnosed breast cancer patients in order to facilitate pre-surgical genetic counseling and testing. METHODS We recruited newly diagnosed breast cancer patients at increased risk for carrying a BRCA1/2 mutation. Of 379 eligible patients who completed a baseline survey, 330 agreed to randomization in a 2:1 ratio to RGCT (n = 220) versus UC (n = 108). Primary outcomes were genetic counseling and testing uptake and breast cancer surgical decisions. RESULTS RGCT led to higher overall (83.8% vs. 54.6%; p < 0.0001) and pre-surgical (57.8% vs. 38.7%; p = 0.001) genetic counseling uptake compared to UC. Despite higher rates of genetic counseling, RGCT did not differ from UC in overall (54.1% vs. 49.1%, p > 0.10) or pre-surgical (30.6% vs. 27.4%, p > 0.10) receipt of genetic test results nor did they differ in uptake of bilateral mastectomy (26.6% vs. 21.8%, p > 0.10). CONCLUSIONS Although RGCT yielded increased genetic counseling participation, this did not result in increased rates of pre-surgical genetic testing or impact surgical decisions. These data suggest that those patients most likely to opt for genetic testing at the time of diagnosis are being effectively identified by their surgeons.
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Affiliation(s)
- Marc D Schwartz
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA.
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA.
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Shawna Willey
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Heiddis B Valdimarsdottir
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Rachel Nusbaum
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Suzanne O'Neill
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jessica Heinzmann
- Atlantic Health Services, Carol G. Simon Cancer Center, Summit, NJ, USA
| | - Aliza Zidell
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Katia Khoury
- Georgetown Lombardi Comprehensive Cancer, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, The Harris Building, Washington, DC, 20007, USA
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31
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Hamilton JG, Peshkin BN, Mays D, DeMarco TA, Patenaude AF, Tercyak KP. Maternal perceptions of BRCA genetic counseling communication processes about disclosing cancer risk information to children and adult relatives. Psychooncology 2018; 27:1825-1832. [PMID: 29645321 DOI: 10.1002/pon.4733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Using a novel measure, examine maternal perceptions of the process by which issues pertaining to family communication of BRCA test results are addressed during cancer genetic counseling. METHODS After receiving BRCA results, mothers (N = 211) of minor-age children reported on their counseling experiences with providers using a communication process measure as well as other psychosocial variables. RESULTS The novel Genetic Counseling Communication Process measure demonstrated good internal consistency of its 2 factors: patient-led communication (Cronbach's α = 0.73) and provider-led communication (Cronbach's α = 0.82). Participants most often reported that discussions about family communication of BRCA test results to children and adult relatives were led only by their providers (38.2%-39.2%), as opposed to being led by the patient, both parties, or neither party. Providers were most likely to lead these discussions when mothers had stronger family histories of cancer and expressed more confidence about making a decision to talk to their children about BRCA. However, mothers typically led such discussions if they were raising older children and held more positive attitudes about pediatric BRCA testing. CONCLUSIONS When the assessment of BRCA genetic counseling outcomes includes family communication to potentially at-risk relatives, we learned that most but not all sessions addressed this topic. Cancer family history, child age, and maternal attitudes are important co-factors in these patient-provider communication exchanges. Providers delivering BRCA genetic counseling should be attentive to mothers' information and support needs regarding communicating cancer genetic test results to at-risk relatives, including children.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beth N Peshkin
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Darren Mays
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Tiffani A DeMarco
- Cancer Genetics Program, Inova Translational Medicine Institute, Fairfax, VA, USA
| | | | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
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32
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Interrante MK, Segal H, Peshkin BN, Valdimarsdottir HB, Nusbaum R, Similuk M, DeMarco T, Hooker G, Graves K, Isaacs C, Wood M, McKinnon W, Garber J, McCormick S, Heinzmann J, Kinney AY, Schwartz MD. Randomized Noninferiority Trial of Telephone vs In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer: A 12-Month Follow-Up. JNCI Cancer Spectr 2017; 1:pkx002. [PMID: 31304457 PMCID: PMC6611491 DOI: 10.1093/jncics/pkx002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/08/2017] [Accepted: 07/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Telephone delivery of genetic counseling is an alternative to in-person genetic counseling because it may extend the reach of genetic counseling. Previous reports have established the noninferiority of telephone counseling on short-term psychosocial and decision-making outcomes. Here we examine the long-term impact of telephone counseling (TC) vs in-person counseling (usual care [UC]). METHODS We recruited high-risk women for a noninferiority trial comparing TC with UC. Of 1057 potentially eligible women, 669 were randomly assigned to TC (n = 335) or UC (n = 334), and 512 completed the 12-month follow-up. Primary outcomes were patient-reported satisfaction with genetic testing decision, distress, and quality of life. Secondary outcomes were uptake of cancer risk management strategies. RESULTS TC was noninferior to UC on all primary outcomes. Satisfaction with decision (d = 0.13, lower bound of 97.5% confidence interval [CI] = -0.34) did not cross its one-point noninferiority limit, cancer-specific distress (d = -2.10, upper bound of 97.5% CI = -0.07) did not cross its four-point noninferiority limit, and genetic testing distress (d = -0.27, upper bound of 97.5% CI = 1.46), physical function (d = 0.44, lower bound of 97.5% CI = -0.91) and mental function (d = -0.04, lower bound of 97.5% CI = -1.44) did not cross their 2.5-point noninferiority limit. Bivariate analyses showed no differences in risk-reducing mastectomy or oophorectomy across groups; however, when combined, TC had significantly more risk-reducing surgeries than UC (17.8% vs 10.5%; χ2 = 4.43, P = .04). CONCLUSIONS Findings support telephone delivery of genetic counseling to extend the accessibility of this service without long-term adverse outcomes.
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Affiliation(s)
- Mary K. Interrante
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Hannah Segal
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Beth N. Peshkin
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Heiddis B. Valdimarsdottir
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Rachel Nusbaum
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Morgan Similuk
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Tiffani DeMarco
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Gillian Hooker
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Kristi Graves
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Claudine Isaacs
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Marie Wood
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Wendy McKinnon
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Judy Garber
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Shelley McCormick
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Jessica Heinzmann
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Anita Y. Kinney
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Marc D. Schwartz
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
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33
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Zhang X, Chiang HC, Wang Y, Zhang C, Smith S, Zhao X, Nair SJ, Michalek J, Jatoi I, Lautner M, Oliver B, Wang H, Petit A, Soler T, Brunet J, Mateo F, Angel Pujana M, Poggi E, Chaldekas K, Isaacs C, Peshkin BN, Ochoa O, Chedin F, Theoharis C, Sun LZ, Curiel TJ, Elledge R, Jin VX, Hu Y, Li R. Attenuation of RNA polymerase II pausing mitigates BRCA1-associated R-loop accumulation and tumorigenesis. Nat Commun 2017; 8:15908. [PMID: 28649985 PMCID: PMC5490191 DOI: 10.1038/ncomms15908] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/12/2017] [Indexed: 01/08/2023] Open
Abstract
Most BRCA1-associated breast tumours are basal-like yet originate from luminal progenitors. BRCA1 is best known for its functions in double-strand break repair and resolution of DNA replication stress. However, it is unclear whether loss of these ubiquitously important functions fully explains the cell lineage-specific tumorigenesis. In vitro studies implicate BRCA1 in elimination of R-loops, DNA-RNA hybrid structures involved in transcription and genetic instability. Here we show that R-loops accumulate preferentially in breast luminal epithelial cells, not in basal epithelial or stromal cells, of BRCA1 mutation carriers. Furthermore, R-loops are enriched at the 5' end of those genes with promoter-proximal RNA polymerase II (Pol II) pausing. Genetic ablation of Cobra1, which encodes a Pol II-pausing and BRCA1-binding protein, ameliorates R-loop accumulation and reduces tumorigenesis in Brca1-knockout mouse mammary epithelium. Our studies show that Pol II pausing is an important contributor to BRCA1-associated R-loop accumulation and breast cancer development.
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Affiliation(s)
- Xiaowen Zhang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Huai-Chin Chiang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Yao Wang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Chi Zhang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Sabrina Smith
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Xiayan Zhao
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Sreejith J. Nair
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Joel Michalek
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ismail Jatoi
- Department of Surgery, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Meeghan Lautner
- Department of Surgery, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Boyce Oliver
- Department of Surgery, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Howard Wang
- Department of Surgery, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Anna Petit
- Department of Pathology, University Hospital of Bellvitge, Bellvitge Institute for Biomedical Research (IDIBELL), L’Hospitalet del Llobregat, Barcelona 08908, Spain
| | - Teresa Soler
- Department of Pathology, University Hospital of Bellvitge, Bellvitge Institute for Biomedical Research (IDIBELL), L’Hospitalet del Llobregat, Barcelona 08908, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO), Girona Biomedical Research Institute (IDIBGI), Girona 17007, Spain
| | - Francesca Mateo
- Breast Cancer and Systems Biology Lab, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L’Hospitalet del Llobregat, Barcelona 08908, Spain
| | - Miguel Angel Pujana
- Breast Cancer and Systems Biology Lab, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L’Hospitalet del Llobregat, Barcelona 08908, Spain
| | - Elizabeth Poggi
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia 20007, USA
| | - Krysta Chaldekas
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia 20007, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia 20007, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia 20007, USA
| | - Oscar Ochoa
- PRMA Plastic Surgery, San Antonio, Texas 78240, USA
| | - Frederic Chedin
- Department of Molecular and Cellular Biology, University of California, Davis, California 95616, USA
| | | | - Lu-Zhe Sun
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Tyler J. Curiel
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Richard Elledge
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Victor X. Jin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Yanfen Hu
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Rong Li
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, Texas 78229, USA
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34
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Walker LC, Marquart L, Pearson JF, Wiggins GAR, O'Mara TA, Parsons MT, Barrowdale D, McGuffog L, Dennis J, Benitez J, Slavin TP, Radice P, Frost D, Godwin AK, Meindl A, Schmutzler RK, Isaacs C, Peshkin BN, Caldes T, Hogervorst FBL, Lazaro C, Jakubowska A, Montagna M, Chen X, Offit K, Hulick PJ, Andrulis IL, Lindblom A, Nussbaum RL, Nathanson KL, Chenevix-Trench G, Antoniou AC, Couch FJ, Spurdle AB. Evaluation of copy-number variants as modifiers of breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. Eur J Hum Genet 2017; 25:432-438. [PMID: 28145423 PMCID: PMC5386423 DOI: 10.1038/ejhg.2016.203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 11/08/2022] Open
Abstract
Genome-wide studies of patients carrying pathogenic variants (mutations) in BRCA1 or BRCA2 have reported strong associations between single-nucleotide polymorphisms (SNPs) and cancer risk. To conduct the first genome-wide association analysis of copy-number variants (CNVs) with breast or ovarian cancer risk in a cohort of 2500 BRCA1 pathogenic variant carriers, CNV discovery was performed using multiple calling algorithms and Illumina 610k SNP array data from a previously published genome-wide association study. Our analysis, which focused on functionally disruptive genomic deletions overlapping gene regions, identified a number of loci associated with risk of breast or ovarian cancer for BRCA1 pathogenic variant carriers. Despite only including putative deletions called by at least two or more algorithms, detection of selected CNVs by ancillary molecular technologies only confirmed 40% of predicted common (>1% allele frequency) variants. These include four loci that were associated (unadjusted P<0.05) with breast cancer (GTF2H2, ZNF385B, NAALADL2 and PSG5), and two loci associated with ovarian cancer (CYP2A7 and OR2A1). An interesting finding from this study was an association of a validated CNV deletion at the CYP2A7 locus (19q13.2) with decreased ovarian cancer risk (relative risk=0.50, P=0.007). Genomic analysis found this deletion coincides with a region displaying strong regulatory potential in ovarian tissue, but not in breast epithelial cells. This study highlighted the need to verify CNVs in vitro, but also provides evidence that experimentally validated CNVs (with plausible biological consequences) can modify risk of breast or ovarian cancer in BRCA1 pathogenic variant carriers.
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Affiliation(s)
- Logan C Walker
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Louise Marquart
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John F Pearson
- Biostatistics and Computational Biology Unit, Department of the Dean, University of Otago, Christchurch, New Zealand
| | | | - Tracy A O'Mara
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Michael T Parsons
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - BCFR
- Department of Epidemiology, Cancer Prevention Institute of California, Fremont, CA, USA
| | - Daniel Barrowdale
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Lesley McGuffog
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Joe Dennis
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Javier Benitez
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - Thomas P Slavin
- Department of Population Sciences Division of Clinical Cancer Genomics, City of Hope Clinical Cancer Genomics Community Research Network, Duarte, CA, USA
| | - Paolo Radice
- Department of Preventive and Predictive Medicine, Unit of Molecular Bases of Genetic Risk and Genetic Testing, Fondazione IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Debra Frost
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - EMBRACE
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alfons Meindl
- Department of Gynaecology and Obstetrics, Division of Tumor Genetics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rita Katharina Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - GEMO Study Collaborators
- Department of Tumour Biology, Institut Curie, Paris, France
- Institut Curie, INSERM, Paris, France
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Trinidad Caldes
- Molecular Oncology Laboratory CIBERONC, Hospital Clinico San Carlos, IdISSC (El Instituto de Investigación Sanitaria del Hospital Clínico San Carlos), Madrid, Spain
| | - Frans BL Hogervorst
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - HEBON
- The Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON), Coordinating center: Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Conxi Lazaro
- Molecular Diagnostic Unit, Hereditary Cancer Program, IDIBELL (Bellvitge Biomedical Research Institute), Catalan Institute of Oncology, Gran Via de l'Hospitalet, Barcelona, Spain
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - KConFab Investigators
- kConFab, Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
| | - Xiaoqing Chen
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kenneth Offit
- Department of Medicine, Cancer Biology and Genetics, Clinical Genetics Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Robert L Nussbaum
- Department of Medicine and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Katherine L Nathanson
- Department of Medicine and the Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Georgia Chenevix-Trench
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Amanda B Spurdle
- Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Evans C, Hamilton RJ, Tercyak KP, Peshkin BN, Rabemananjara K, Isaacs C, O'Neill SC. Understanding the Needs of Young Women Regarding Breast Cancer Risk Assessment and Genetic Testing: Convergence and Divergence among Patient-Counselor Perceptions and the Promise of Peer Support. Healthcare (Basel) 2016; 4:healthcare4030035. [PMID: 27417623 PMCID: PMC5041036 DOI: 10.3390/healthcare4030035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/10/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022] Open
Abstract
Young women from hereditary breast and ovarian cancer (HBOC) families face a series of medical decisions regarding their cancer risk management and integrating this information into their life planning. This presents unique medical and psychosocial challenges that exist without comprehensive intervention. To help lay the groundwork for intervention, we conducted a qualitative study among young women from HBOC families (N = 12; Mean age = 22) and cancer genetic counselors (N = 12) to explicate domains most critical to caring for this population. Women and counselors were interviewed by telephone. The predominant interview themes included preventative care planning and risk management, decision making around the pros and cons of cancer risk assessment, medical management, and psychosocial stresses experienced. Young women endorsed psychosocial stress significantly more frequently than did counselors. Both groups noted the short- and long-term decision making challenges and the support and conflict engendered among familial relationships. Our results suggest young women value the support they receive from their families and their genetic counselors, but additional, external supports are needed to facilitate adaptation to HBOC risk. In feedback interviews focused on intervention planning with a subset of these young women (N = 9), they endorsed the predominant interview themes discovered as important intervention content, a structure that would balance discussion of medical information and psychosocial skill-building that could be tailored to the young women’s needs, and delivery by trained peers familiar with HBOC risk.
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Affiliation(s)
- Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
| | - Rebekah J Hamilton
- College of Nursing, Armour Academic Center, Rush University, 600 S. Paulina Street, Suite 1080, Chicago, IL 60612, USA.
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
| | - Kantoniony Rabemananjara
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
| | - Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Peshkin BN, Kelly S, Nusbaum RH, Similuk M, DeMarco TA, Hooker GW, Valdimarsdottir HB, Forman AD, Joines JR, Davis C, McCormick SR, McKinnon W, Graves KD, Isaacs C, Garber J, Wood M, Jandorf L, Schwartz MD. Patient Perceptions of Telephone vs. In-Person BRCA1/BRCA2 Genetic Counseling. J Genet Couns 2016; 25:472-82. [PMID: 26455498 PMCID: PMC4829475 DOI: 10.1007/s10897-015-9897-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women's perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants (TC, N = 272; UC, N = 282), delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants (OR = 4.78, 95 % CI = 3.32, 6.89) while also perceiving lower levels of support (OR = 0.56, 95 % CI = 0.40-0.80) and emotional recognition (OR = 0.53, 95 % CI = 0.37-0.76). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC (69.4 % vs. 52.8 %; OR = 3.06, 95 % CI = 1.39-6.74), while minority women perceived less support in UC vs. TC (58.3 % vs. 38.7 %; OR = 0.80, 95 % CI = 0.39-1.65). We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.
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Affiliation(s)
- Beth N Peshkin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Scott Kelly
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | | | - Morgan Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tiffani A DeMarco
- Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA, USA
| | | | - Heiddis B Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reyjavik University, Reyjavik, Iceland
| | - Andrea D Forman
- Department of Clinical Genetics, Risk Assessment Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jessica Rispoli Joines
- Department of Medicine, Division of Hematology/Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Claire Davis
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Yonkers, NY, USA
| | - Shelley R McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Wendy McKinnon
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Marie Wood
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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Roesch EE, Peshkin BN, Johnson A, Murphy S, Hamilton R, Friedman S, Isaacs C, Tercyak K, O'Neill SC. Factors associated with BRCA 1/2 testing among young women from hereditary breast and ovarian cancer families. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Beth N. Peshkin
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Andrea Johnson
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sarah Murphy
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Sue Friedman
- FORCE-Facing our Risk of Cancer Empowered, Tampa, FL
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Kenneth Tercyak
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Suzanne C. O'Neill
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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Chang Y, Near AM, Butler KM, Hoeffken A, Edwards SL, Stroup AM, Kohlmann W, Gammon A, Buys SS, Schwartz MD, Peshkin BN, Kinney AY, Mandelblatt JS, Chang Y, Near AM, Butler KM, Hoeffken A, Edwards SL, Stroup AM, Kohlmann W, Gammon A, Buys SS, Schwartz MD, Peshkin BN, Kinney AY, Mandelblatt JS. Economic Evaluation Alongside a Clinical Trial of Telephone Versus In-Person Genetic Counseling for BRCA1/2 Mutations in Geographically Underserved Areas. J Oncol Pract 2016; 12:59, e1-13. [PMID: 26759468 PMCID: PMC4960460 DOI: 10.1200/jop.2015.004838] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE BRCA1/2 counseling and mutation testing is recommended for high-risk women, but geographic barriers exist, and no data on the costs and yields of diverse delivery approaches are available. METHODS We performed an economic evaluation with a randomized clinical trial comparing telephone versus in-person counseling at 14 locations (nine geographically remote). Costs included fixed overhead, variable staff, and patient time costs; research costs were excluded. Outcomes included average per-person costs for pretest counseling; mutations detected; and overall counseling, testing, and disclosure. Sensitivity analyses were performed to assess the impact of uncertainty. RESULTS In-person counseling was more costly per person counseled than was telephone counseling ($270 [range, $180 to $400] v $120 [range, $80 to $200], respectively). Counselors averaged 285 miles round-trip to deliver in-person counseling to the participants (three participants per session). There were no differences by arm in mutation detection rates (approximately 10%); therefore, telephone counseling was less costly per positive mutation detected than was in-person counseling ($37,160 [range, $36,080 to$38,920] v $40,330 [range, $38,010 to $43,870]). In-person counseling would only be less costly than telephone counseling if the most favorable assumptions were applied to in personc ounseling and the least favorable assumptions were applied to telephone counseling. CONCLUSION In geographically underserved areas, telephone counseling is less costly than in-person counseling.
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Affiliation(s)
- Yaojen Chang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aimee M. Near
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karin M. Butler
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Hoeffken
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sandra L. Edwards
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Antoinette M. Stroup
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Gammon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Saundra S. Buys
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marc D. Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Anita Y. Kinney
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Corresponding author: Jeanne S. Mandelblatt, MD, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St NW, Suite 4100, Washington, DC 20007; e-mail:
| | - Yaojen Chang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aimee M Near
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karin M Butler
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Hoeffken
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sandra L Edwards
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Antoinette M Stroup
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Gammon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Saundra S Buys
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Anita Y Kinney
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeanne S Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Quinn GP, Peshkin BN, Sehovic I, Bowman M, Tamargo C, Vadaparampil ST. Oncofertility in adolescent and young adult hereditary cancer: Considerations for genetics professionals. World J Med Genet 2015; 5:52-59. [DOI: 10.5496/wjmg.v5.i4.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/07/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Adolescents and young adults (AYA) with a cancer diagnosis or those at risk for cancer due to hereditary cancer syndromes may benefit from genetic counseling and testing not only to manage personal risk but also to address reproductive concerns, especially fertility. The opportunity for genetic counselors to provide important risk information is relevant to both the newly diagnosed as well as to unaffected carriers and survivors. However, genetic counselors may need additional training in reproductive options related to AYA cancer to provide this valuable counsel. This commentary uses hereditary breast and ovarian cancer syndrome as a model to highlight important considerations when discussing preimplanatation genetic diagnosis and prenatal diagnosis, particularly in the context of expanded testing for hereditary cancer risk including multigene panels or whole exome or whole genome sequencing. Other hereditary cancers are also addressed; however, less is known about the psychosocial and fertility concerns in these AYA populations. Additionally, we provide an overview of the concept of “oncofertility” - the linkage between cancer care and reproductive medicine that aims to expand the reproductive opportunities of cancer patients - and offer support for the expansion of guidelines to include genetic counselors in AYA cancer patients’ treatment planning related to reproductive health and fertility.
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40
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Peshkin BN, Vadaparampil ST, Hoskins LM, O'Neill SM, Barter JF. Genetic counseling and testing for hereditary cancer risk in young adult women: Facilitating autonomy and informed decision making is key. Gynecol Oncol Rep 2015; 14:44-5. [PMID: 26793774 PMCID: PMC4688888 DOI: 10.1016/j.gore.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Beth N. Peshkin
- Georgetown University, Department of Oncology, Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
- Corresponding author at: 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.3300 Whitehaven Street, NW, Suite 4100Washington, DC20007USA
| | | | | | - Suzanne M. O'Neill
- Northwestern University Medical Center, Graduate Program in Genetic Counseling, Chicago, IL, USA
| | - James F. Barter
- Women's Health Specialists of Montgomery County, PA, Holy Cross Hospital, Silver Spring, MD, USA
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Abstract
We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.
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O'Neill SC, Mays D, Patenaude AF, Garber JE, DeMarco TA, Peshkin BN, Schneider KA, Tercyak KP. Women's concerns about the emotional impact of awareness of heritable breast cancer risk and its implications for their children. J Community Genet 2014; 6:55-62. [PMID: 25099078 DOI: 10.1007/s12687-014-0201-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/23/2014] [Indexed: 12/27/2022] Open
Abstract
Women tested for mutations in BRCA1/2 genes who have minor-aged children confront difficult decisions about if, when, and how to share information about hereditary cancer risk with their children. These choices are often seemingly influenced by how mothers anticipate the emotional burdens they and their children will experience in response to test results. Here, we investigate the association between maternal cognitions, pretest psychological well-being, and coping style with mothers' anticipated emotional reactions to learning that they are BRCA1/2 mutation carriers (N = 205). In a linear regression model adjusted for maternal demographics, stronger tendencies to ruminate about information (B = .14, p = .03), greater psychological strain (B = .14, p < .001), and poorer appraisals of one's ability to cope with genetic test results conveying increased breast cancer risk information (B = -.25, p < .001) were significantly associated with anticipating more negative affect surrounding BRCA1/2 mutation identification in mothers. Our data contribute to the growing awareness of special concerns that mothers have about knowing their BRCA1/2 mutation status and highlight the need for more tailored patient education and counseling resources to improve outcomes among women at risk and their children.
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Affiliation(s)
- Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA,
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Tong A, Kelly S, Nusbaum R, Graves K, Peshkin BN, Valdimarsdottir HB, Wood M, McKinnon W, Garber J, McCormick SR, Jandorf L, Schwartz MD. Intentions for risk-reducing surgery among high-risk women referred for BRCA1/BRCA2 genetic counseling. Psychooncology 2014; 24:33-9. [PMID: 24839250 DOI: 10.1002/pon.3560] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/22/2014] [Accepted: 03/28/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Genetic testing for breast and ovarian cancer susceptibility is now part of routine clinical practice. Although rates of risk-reducing surgery following genetic testing have been increasing, little is known about attitudes toward risk-reducing surgery in women prior to genetic counseling and testing. This study examines correlates of patient intentions to undergo risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). METHODS Participants were 696 women, ages 21-85, who sought breast cancer gene 1 and 2 (BRCA1/2) genetic counseling and had at least a 10% risk of carrying a mutation. The sample included women who were affected with breast or ovarian cancer and unaffected women with a known familial BRCA1/2 mutation. Participants completed a precounseling telephone questionnaire. RESULTS Prior to receiving genetic counseling, 23.3% of participants were considering RRM and 42.5% were considering RRO. Variables that were independently associated with RRM intentions were cancer-specific distress (OR = 1.14, 95% CI = 1.03-1.26), perceived risk of breast cancer (OR = 1.16, 95% CI = 1.05-1.28), education (OR = 1.76, 95% CI = 1.03-2.99), and age (OR = 0.96, 95% CI = 0.95-0.98). Predictors of RRO intentions were perceived risk for ovarian cancer (OR = 1.25, 95% CI = 1.14-1.37), perceived risk of carrying a BRCA1/2 mutation (OR = 1.74, 95% CI = 1.15-2.62), marital status (OR = 1.92, 95% CI = 1.34-2.76), and age (OR = 1.02, 95% CI = 1.00-1.03). CONCLUSIONS Because precounseling intentions predict subsequent risk-reducing surgery decisions, this study identified patient factors associated with surgical intentions. These factors reinforce the critical role for pretest genetic counseling in communicating accurate risk estimates and management options, and addressing psychosocial concerns, to facilitate informed decision making regarding RRM and RRO.
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Affiliation(s)
- Angie Tong
- Lombardi Comprehensive Cancer Center/Georgetown University, Oncology, Washington, DC, USA
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Butrick MN, Vanhusen L, Leventhal KG, Hooker GW, Nusbaum R, Peshkin BN, Salehizadeh Y, Pavlick J, Schwartz MD, Graves KD. Discussing race-related limitations of genomic testing for colon cancer risk: implications for education and counseling. Soc Sci Med 2014; 114:26-37. [PMID: 24908172 DOI: 10.1016/j.socscimed.2014.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 12/23/2022]
Abstract
This study examines communication about limitations of genomic results interpretation for colon cancer risk during education and counseling of minority participants. As part of a larger study conducted from 2010 to 2012, participants recruited from a large primary care clinic were offered testing for a research panel of 3 genomic markers (single nucleotide polymorphisms or SNPs) for colorectal cancer risk. Genetic counselors conducted pre- and post-test sessions which included discussion of limitations of result interpretation due to the lack of racial/ethnic diversity in research populations from which risk data are derived. Sessions were audio-recorded, transcribed and thematically analyzed. Many participants did not respond directly to this limitation. Among the participants that responded directly to this race-related limitation, many responses were negative. However, a few participants connected the limited minority information about SNPs with the importance of their current research participation. Genetic counselor discussions of this limitation were biomedically focused with limited explanations for the lacking data. The communication process themes identified included: low immediacy (infrequent use of language directly involving a participant), verbal dominance (greater speaking ratio of the counselor to the patient) and wide variation in the degree of interactivity (or the amount of turn-taking during the discussion). Placed within the larger literature on patient-provider communication, these present results provide insight into the dynamics surrounding race-related educational content for genomic testing and other emerging technologies. Clinicians may be better able to engage patients in the use of new genomic technology by increasing their awareness of specific communication processes and patterns during education or counseling sessions.
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Affiliation(s)
- Morgan N Butrick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Lauren Vanhusen
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kara-Grace Leventhal
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Gillian W Hooker
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Rachel Nusbaum
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Beth N Peshkin
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Yasmin Salehizadeh
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Jessica Pavlick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Marc D Schwartz
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kristi D Graves
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Hooker GW, King L, Vanhusen L, Graves K, Peshkin BN, Isaacs C, Taylor KL, Poggi E, Schwartz MD. Long-term satisfaction and quality of life following risk reducing surgery in BRCA1/2 mutation carriers. Hered Cancer Clin Pract 2014; 12:9. [PMID: 24690515 PMCID: PMC3977895 DOI: 10.1186/1897-4287-12-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 03/25/2014] [Indexed: 12/17/2022] Open
Abstract
Background As BRCA1/2 testing becomes more routine, questions remain about long-term satisfaction and quality of life following testing. Previously, we described long term distress and risk management outcomes among women with BRCA1/2 mutations. This study addresses positive psychological outcomes in BRCA1/2 carriers, describing decision satisfaction and quality of life in the years following testing. Methods We evaluated satisfaction with testing and management decisions among 144 BRCA1/2 carriers. Prior to genetic testing, we assessed family history, sociodemographics and distress. At a mean of 5.3 years post-testing, we assessed management decisions, satisfaction with decisions and, among women with cancer, quality of life. Results Overall, satisfaction with decision making was high. Women who had risk reducing mastectomy or oophorectomy were more satisfied with management decisions. Participants who obtained a risk reducing oophorectomy were more satisfied with their genetic testing decision. Among affected carriers, high pretest anxiety was associated with poorer quality of life and having had risk reducing mastectomy prior to testing was associated with better quality of life. The negative impact of pre-test anxiety was diminished among women who had mastectomies before testing. Conclusions BRCA1/2 carriers are satisfied with their testing and risk management decisions and report good quality of life years after testing. Having risk reducing surgery predicts increased satisfaction and improved quality of life.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marc D Schwartz
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA.
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Schwartz MD, Valdimarsdottir HB, Peshkin BN, Mandelblatt J, Nusbaum R, Huang AT, Chang Y, Graves K, Isaacs C, Wood M, McKinnon W, Garber J, McCormick S, Kinney AY, Luta G, Kelleher S, Leventhal KG, Vegella P, Tong A, King L. Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer. J Clin Oncol 2014; 32:618-26. [PMID: 24449235 DOI: 10.1200/jco.2013.51.3226] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Although guidelines recommend in-person counseling before BRCA1/BRCA2 gene testing, genetic counseling is increasingly offered by telephone. As genomic testing becomes more common, evaluating alternative delivery approaches becomes increasingly salient. We tested whether telephone delivery of BRCA1/2 genetic counseling was noninferior to in-person delivery. PATIENTS AND METHODS Participants (women age 21 to 85 years who did not have newly diagnosed or metastatic cancer and lived within a study site catchment area) were randomly assigned to usual care (UC; n = 334) or telephone counseling (TC; n = 335). UC participants received in-person pre- and post-test counseling; TC participants completed all counseling by telephone. Primary outcomes were knowledge, satisfaction, decision conflict, distress, and quality of life; secondary outcomes were equivalence of BRCA1/2 test uptake and costs of delivering TC versus UC. RESULTS TC was noninferior to UC on all primary outcomes. At 2 weeks after pretest counseling, knowledge (d = 0.03; lower bound of 97.5% CI, -0.61), perceived stress (d = -0.12; upper bound of 97.5% CI, 0.21), and satisfaction (d = -0.16; lower bound of 97.5% CI, -0.70) had group differences and confidence intervals that did not cross their 1-point noninferiority limits. Decision conflict (d = 1.1; upper bound of 97.5% CI, 3.3) and cancer distress (d = -1.6; upper bound of 97.5% CI, 0.27) did not cross their 4-point noninferiority limit. Results were comparable at 3 months. TC was not equivalent to UC on BRCA1/2 test uptake (UC, 90.1%; TC, 84.2%). TC yielded cost savings of $114 per patient. CONCLUSION Genetic counseling can be effectively and efficiently delivered via telephone to increase access and decrease costs.
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Affiliation(s)
- Marc D Schwartz
- Marc D. Schwartz, Beth N. Peshkin, Jeanne Mandelblatt, Rachel Nusum, An-Tsun Huang, Yaojen Chang, Kristi Graves, Claudine Isaacs, George Luta, Sarah Kelleher, Kara-Grace Leventhal, Patti Vegella, Angie Tong, and Lesley King, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Heiddis B. Valdimarsdottir, Mount Sinai School of Medicine, New York, NY; Marie Wood and Wendy McKinnon, Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT; Judy Garber and Shelley McCormick, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA; and Anita Y. Kinney, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
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Tercyak KP, Mays D, DeMarco TA, Peshkin BN, Valdimarsdottir HB, Schneider KA, Garber JE, Patenaude AF. Decisional outcomes of maternal disclosure of BRCA1/2 genetic test results to children. Cancer Epidemiol Biomarkers Prev 2013; 22:1260-6. [PMID: 23825307 DOI: 10.1158/1055-9965.epi-13-0198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although BRCA1/2 genetic testing is discouraged in minors, mothers may disclose their own results to their children. Factors affecting patients' disclosure decisions and patient outcomes of disclosure are largely unknown. METHODS Mothers (N = 221) of children aged 8 to 21 years enrolled in this prospective study of family communication about cancer genetic testing. Patients underwent BRCA1/2 genetic counseling and testing, and completed standardized behavioral assessments before and 1-month following receipt of their results. RESULTS Most patients (62.4%) disclosed BRCA1/2 test results to their child. Patients were more likely to disclose if they received negative or uninformative versus positive results [OR = 3.11; 95% confidence interval (CI), 1.11-8.71; P = .03], their child was 13 years of age or more versus younger (OR = 5.43; 95% CI, 2.18-13.53; P < .001), and as the ratio of patients' perceived benefits of disclosure outweighed potential risks (OR = 2.40; 95% CI, 1.63-3.54; P < .001). Postdecision satisfaction about disclosure was lowest among nondisclosing patients (P < .001) and those reporting greater decisional conflict (P < .001). CONCLUSIONS Patients commonly discuss their BRCA1/2 results with their teenage and young adult children, especially if the information is perceived as beneficial. Satisfaction with disclosure decision making remains lowest among nondisclosing and conflicted patients. Family communication decision support adjuncts to genetic counseling are needed to help ameliorate these effects. IMPACT This study describes the prevalence of family communication about maternal BRCA1/2 genetic testing with minor children, and decisions and outcomes of disclosure.
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Affiliation(s)
- Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
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Mays D, DeMarco TA, Luta G, Peshkin BN, Patenaude AF, Schneider KA, Garber JE, Tercyak KP. Distress and the parenting dynamic among BRCA1/2 tested mothers and their partners. Health Psychol 2013; 33:765-73. [PMID: 23795707 DOI: 10.1037/a0033418] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the influence of dyadic parenting relationships on psychological distress among mothers tested for BRCA1/2 genetic mutations and their untested partners. METHODS Data were from a prospective study of mothers suspected to be at risk for hereditary breast/ovarian cancer who underwent genetic counseling and BRCA1/2 testing and their untested parenting partners (n = 109 parenting dyads). Participants completed assessments before and 1 month after genetic testing. Structural equation modeling was used to examine relationships among mothers' and partners' psychological distress, decisional conflict surrounding communication of test results to their offspring, and the parent-child communication relationship. Psychological distress was measured using items modified from the Brief Symptom Inventory. RESULTS Among mothers, greater psychological distress (B = 0.29, p < .001) and poorer parent-child communication (B = -0.12, p < .01) at baseline predicted greater distress at follow-up. Among partners, greater distress at baseline predicted greater distress at follow-up (B = 0.67, p < .001). Mother and partner decisional conflict at baseline were equally associated with the other dyad member's distress at follow-up (B = 1.17, p < .01), but not their own distress. CONCLUSIONS Our findings indicate that conflicted decision-making over family communication of hereditary breast/ovarian cancer genetic test results for one member of a parenting dyad adversely affects the other dyad member's psychological well-being. Interventions to improve outcomes for mothers who may be at-risk for hereditary breast and ovarian cancer and undergoing BRCA1/2 genetic testing should attend to mothers' and their partners' preferences regarding family communication about hereditary cancer risk.
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Affiliation(s)
- Darren Mays
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Tiffani A DeMarco
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Beth N Peshkin
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Andrea F Patenaude
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute
| | | | - Judy E Garber
- Center for Cancer Genetics & Prevention, Dana-Farber Cancer Institute
| | - Kenneth P Tercyak
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
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Mays D, Sharff ME, DeMarco TA, Williams B, Beck B, Sheppard VB, Peshkin BN, Eng-Wong J, Tercyak KP. Outcomes of a systems-level intervention offering breast cancer risk assessments to low-income underserved women. Fam Cancer 2013; 11:493-502. [PMID: 22711611 DOI: 10.1007/s10689-012-9541-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hereditary breast and ovarian cancer risk assessments (CRAs) are underutilized by low-income and racial/ethnic minority women, potentially exacerbating cancer-related disparities observed within these populations. We deployed and evaluated a systems-level intervention designed to identify patients potentially at-risk for hereditary breast/ovarian cancer, refer them for CRAs, and facilitate CRA utilization at an urban community-based breast health care center. Cancer family history forms were completed by patients seen at the center during an 18-month period and reviewed by staff for CRA eligibility against published referral criteria. A patient navigator educated eligible patients about the benefits of CRA, navigating interested patients to this service. CRA-specific patient interest and utilization outcomes are reported. In total, 94.7 % of all patients (n = 2,436) completed forms and 65 patients (2.7 %) met CRA eligibility criteria. Most eligible patients (72.3 %) were interested in CRA. Interested patients had a greater risk for hereditary breast/ovarian cancer (i.e., more affected relatives, greater objective risk scores) than uninterested patients: 57.4 % scheduled a CRA appointment and 51.9 % of scheduled patients utilized CRAs. Patients scheduling a CRA were contacted in less time and required fewer follow-up contacts by the patient navigator, and were more likely to be African American, than those who declined a CRA or were lost to follow-up (all p's ≤ .05). The systems-level intervention successfully identified patients eligible for CRA and linked interested and at-risk patients with CRA resources. More intensive patient navigation addressing the unique barriers encountered within this population may be required to enhance utilization.
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Affiliation(s)
- Darren Mays
- Division of Health Outcomes and Health Behaviors, Department of Oncology, Lombardi Comprehensive Cancer, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
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Graves KD, Leventhal KG, Nusbaum R, Salehizadeh Y, Hooker GW, Peshkin BN, Butrick M, Tuong W, Mathew J, Goerlitz D, Fishman MB, Shields PG, Schwartz MD. Behavioral and psychosocial responses to genomic testing for colorectal cancer risk. Genomics 2013; 102:123-30. [PMID: 23583311 DOI: 10.1016/j.ygeno.2013.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
Abstract
We conducted a translational genomic pilot study to evaluate the impact of genomic information related to colorectal cancer (CRC) risk on psychosocial, behavioral and communication outcomes. In 47 primary care participants, 96% opted for testing of three single nucleotide polymorphisms (SNPs) related to CRC risk. Participants averaged 2.5 of 6 possible SNP risk alleles (10% lifetime risk). At 3-months, participants did not report significant increases in cancer worry/distress; over half reported physical activity and dietary changes. SNP risk scores were unrelated to behavior change at 3-months. Many participants (64%) shared their SNP results, including 28% who shared results with a physician. In this pilot, genomic risk education, including discussion of other risk factors, appeared to impact patients' health behaviors, regardless of the level of SNP risk. Future work can compare risk education with and without SNP results to evaluate if SNP information adds value to existing approaches.
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Affiliation(s)
- Kristi D Graves
- Cancer Prevention and Control Program and the Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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