title: Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing.
abstract: DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered: NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert commentary: As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.
authors.affiliation: a Department of Global Health, College of Public Health , University of South Florida , Tampa , FL , USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cragun
authors.affiliation: b Cancer Control Program , University of New Mexico Comprehensive Cancer Center , Albuquerque , NM , USA.|c Department of Internal Medicine , University of New Mexico , Albuquerque , NM , USA.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
authors.affiliation: d Department of Cancer Epidemiology , Population Sciences, Moffitt Cancer Center , Tampa , FL , USA.
authors.forename: Tuya
authors.initials: T
authors.lastname: Pal
mesh_terms: D003695:Delivery of Health Care; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D015894:Genome, Human; D055106:Genome-Wide Association Study; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D009369:Neoplasms / Q000235:genetics* / Q000628:therapy*
keywords: Genetic testing; health disparities; inherited cancer; multi-gene panel testing; next-generation sequencing