Predictors of patient uptake of colorectal cancer gene environment risk assessment

Abstract

BackgroundIn an ongoing clinical trial, the genetic and environmental risk assessment (GERA) blood test offers subjects information about personal colorectal cancer risk through measurement of two novel low-to-moderate risk factors. We sought to examine predictors of uptake of the GERA blood test among participants randomized to the Intervention arm.MethodsPrimary care patients aged 50 to 74 years eligible for colorectal cancer screening are randomized to receive a mailed stool blood test kit to complete at home (Control) or to the control condition plus an in-office blood test called GERA that includes assessment of red blood cell folate and DNA-testing for two MTHFR (methylenetetrahydrofolate reductase) single nucleotide polymorphisms (SNPs) (Intervention). For the present study, baseline survey data are examined in participants randomized to the Intervention.ResultsThe first 351 intervention participants (161 African American/190 white) were identified. Overall, 249 (70.9%) completed GERA testing. Predictors of GERA uptake included race (African American race, odds ratio (OR) 0.51 (0.29 to 0.87)), and being more knowledgeable about GERA and colorectal cancer screening (OR 1.09 (1.01 to 1.18)). Being married (OR 1.81 (1.09 to 3.00)) was also significant in the multivariable model.ConclusionsParticipant uptake of GERA testing was high. GERA uptake varied, however, according to socio-demographic background and knowledge.

Discussing race-related limitations of genomic testing for colon cancer risk: Implications for education and counseling

“…Understanding the factors that contribute to differential rates of genomic and genetic testing uptake among minorities is an active area of study (Corbie-Smith et al, 2008; Hall et al, 2012; Sheppard, Mays, LaVeist, & Tercyak, 2013). Recent research suggests that participation of racial and ethnic minorities in genetic services may reflect informed decisions not to have testing (Halbert et al, 2012), challenges with the provision of referral to such services (Graves et al, 2011) or cultural influences that may decrease the salience of such information (Glenn, Chawla, & Bastani, 2012) is unclear.…”

“…Recent research suggests that participation of racial and ethnic minorities in genetic services may reflect informed decisions not to have testing (Halbert et al, 2012), challenges with the provision of referral to such services (Graves et al, 2011) or cultural influences that may decrease the salience of such information (Glenn, Chawla, & Bastani, 2012) is unclear. In one recent study, African Americans had lower rates of testing for a genomic test that described an increased risk for colorectal cancer based on a genetic and environmental interaction (Hall et al, 2012). The high rate of genomic testing uptake among minorities in the present study may have been due to the availability of free testing, although free testing has also been available in prior work with contrasting findings (Halbert et al, 2012; Hall et al, 2012).…”

“…In one recent study, African Americans had lower rates of testing for a genomic test that described an increased risk for colorectal cancer based on a genetic and environmental interaction (Hall et al, 2012). The high rate of genomic testing uptake among minorities in the present study may have been due to the availability of free testing, although free testing has also been available in prior work with contrasting findings (Halbert et al, 2012; Hall et al, 2012). Future work can further explore the individual, social and contextual factors that may influence uptake of genomic testing.…”

Bumps Along the Translational Pathway: Anticipating Uptake of Tailored Smoking Cessation Treatment

“…African Americans, however, have been shown to be approximately half as likely as white Americans to undergo genetic assessment for colorectal cancer risk [46]. Willingness to undergo testing has been shown to be inversely related to factors such as knowledge about genetics [46], being tested by a specialist [47], race-specific marketing [47] and disclosure of test results to insurers [47].…”

“…African Americans, however, have been shown to be approximately half as likely as white Americans to undergo genetic assessment for colorectal cancer risk [46]. Willingness to undergo testing has been shown to be inversely related to factors such as knowledge about genetics [46], being tested by a specialist [47], race-specific marketing [47] and disclosure of test results to insurers [47]. Of the few studies to examine actual testing uptake, genetic testing rates remained low, even when stated willingness to be tested [48] and knowledge of BRCA1/2 testing [49] or BRCA1/2 counseling rates [50] were high.…”