Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial

Abstract

Purpose We evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes. Methods In this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were randomized to the intervention (n = 513; saliva sample for genetic testing, personalized melanoma risk booklet based on a 40-variant polygenic risk score, telephone-based genetic counseling, educational booklet) or control (n = 512; educational booklet). Wrist-worn ultraviolet (UV) radiation dosimeters (10-day wear) and questionnaires were administered at baseline, 1 month postintervention, and 12 months postbaseline. Results At 12 months, 948 (92%) participants completed dosimetry and 973 (95%) the questionnaire. For the primary outcome, there was no effect of the genomic risk intervention on objectively measured UV exposure at 12 months, irrespective of traditional risk factors. For secondary outcomes at 12 months, the intervention reduced sunburns (risk ratio: 0.72, 95% confidence interval: 0.54–0.96), and increased skin examinations among women. Melanoma-related worry was reduced. There was no overall impact on general psychological distress. Conclusion Personalized genomic risk information did not influence sun exposure patterns but did improve some skin cancer prevention and early detection behaviors, suggesting it may be useful for precision prevention. There was no evidence of psychological harm.

Interest and Utility of MC1R Testing for Melanoma Risk in Dermatology Patients with a History of Nonmelanoma Skin Cancer

“…[22,37] In these studies and others, the provision of MC1R and similar melanoma genetic risk test results lead to behavioral activation but not worry and promote increased use of sun protection and skin screening, as well as reductions in sunburn in individuals who received the feedback. Further, individuals who receive average risk feedback do not increase risk behaviors such as tanning [38][39][40]. Current genetic testing technology allows for lowcost comprehensive genomic assessment, and MC1R is often 1.00 (0.00) Afraid [1][2][3][4][5][6][7] 1.50 (1.10) Hopeful [1][2][3][4][5][6][7] 4.63 (2.36) Confused [1][2][3][4][5][6][7] 1.94 (1.61) Determined to change [1][2][3][4][5][6][7] 4.38 (2.53) Distress, Sum 8.81 (2.23) evaluated as part of direct-to-consumer genetic tests.…”

The Future of Precision Prevention for Advanced Melanoma

“…Early studies in diverse disease groups show that communication of this risk information is not associated with undue psychological sequelae or adverse health behaviors (41). In keeping with familial melanoma testing, initial studies communicating melanoma PRS in the general population show no impact on psychological distress and a positive improvement in some primary preventative behaviors (42).…”

Precision Public Health Initiatives in Cancer: Proceedings from the Transdisciplinary Conference for Future Leaders in Precision Public Health

“…This included examples from research in melanoma, beginning with the translation of genetic epidemiology findings to clinical and public health practice. Dr. Kanetsky specifically discussed the IMPACT-ME study, [ 7 ] the Melanoma Genomics Managing Your Risk Study, [ 8 ] and SOMBRA study all focused on intervention research to reduce melanoma and skin cancer [ 9 ]. Future directions in cancer genetic epidemiology research include hybrid type 1 effectiveness-implementation studies, examining the long-term impacts of precision prevention approaches, cross-generational effects of precision prevention, and increasing inclusion of Hispanics in longitudinal melanoma research.…”