title: Multilevel research and the challenges of implementing genomic medicine.
abstract: Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum.
authors.affiliation: Office of Public Health Genomics, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E61, Atlanta, GA 30333, USA. muk1@cdc.gov
authors.forename: Muin J
authors.initials: MJ
authors.lastname: Khoury
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Coates
authors.forename: Mary L
authors.initials: ML
authors.lastname: Fennell
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Maren T
authors.initials: MT
authors.lastname: Scheuner
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Schully
authors.forename: Marc S
authors.initials: MS
authors.lastname: Williams
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clauser
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis / Q000235:genetics; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards / Q000639:trends; D019317:Evidence-Based Medicine; D005820:Genetic Testing; D023281:Genomics; D006291:Health Policy; D006302:Health Services Research / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D008484:Medicaid; D006278:Medicare; D009154:Mutation; D009369:Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D010348:Patient Care Team / Q000592:standards / Q000639:trends; D010820:Physicians / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D057285:Precision Medicine; D011787:Quality of Health Care / Q000592:standards / Q000639:trends; D012107:Research Design; D057170:Translational Research, Biomedical / Q000379:methods / Q000458:organization & administration / Q000592:standards / Q000639:trends; D014481:United States