Abstract B7: Use of risk assessment services and predictive genetic testing (PGT) for hereditary gastrointestinal (GI) cancers: How do men and women differ?
Authors: Hall Michael J. , Mazar Carla , Rybak Christina , Balshem Andrew , Manne Sharon L. , Slater Elyse , Weinberg David S. , Meropol Neal J. 
Published: May 2012

Background: Uptake of risk assessment and PGT for hereditary GI cancer risk has lagged far behind that of the hereditary breast-ovarian cancer syndrome and BRCA1/2, despite the parallel clinical availability of genetic services for hereditary GI cancers, the proportion of patients with incident colorectal cancers who demonstrate familial risk (∼ 1 in 3), and the prevalence of Lynch syndrome associated mismatch repair gene mutations among incident colorectal cancers (∼ 3–5%). The bulk of data on perceptions of PGT have focused on women considering BRCA1/2 testing for personal and/or familial risk estimation. Studies in men are less plentiful, and have often focused on men's opinions about PGT for prostate cancer risk, although clinical PGT for hereditary prostate cancer is not currently available. Individuals enrolled in a high-risk GI cancer registry represent a unique population in which important differences in perceptions of PGT between men and women may be directly examined to shed light on barriers to risk assessment and PGT, and cancer prevention services in general, that may differ by gender.

Methods: The GI Tumor Risk Assessment Program (GI-TRAP) registry at Fox Chase Cancer Center enrolls individuals at increased risk for GI cancers because of a suggestive personal or family history. At enrollment and prior to risk education and counseling, participants are asked to complete a detailed personal and family history and a questionnaire examining screening practices and psychosocial aspects of hereditary cancer risk. The GI-TRAP registry currently contains information collected from members of 269 families.

Results: Women (n=293) participants outnumbered men (n=105) almost 3 to 1, were younger (47.0 vs 50.8 yrs)(p=0.01), and were less likely to work full-time (39.9% vs 59.0%)(p&lt;0.001). The most common reasons for wanting testing in both groups were to guide screening (91.4% men, 95.7% women)(p=0.11) and learn children's risks (75.8% men, 83.7% women)(p=0.09). Women were more likely to want testing as a global means to “take better care of myself” (p=0.004), and were more concerned about personal (p=0.05) and family (p=0.04) emotional reactions to testing results, as well as the possible impact of testing on health insurance (p=0.06). Men were more willing to pay for genetic testing (“I plan to get genetic testing even if I have to pay”)(p=0.02) and were more willing to pay larger sums for testing (“I would pay equal to or over $1000 for genetic testing”)(p=0.04).

Conclusions: Compared to women, overall fewer men obtain available risk assessment services for hereditary GI cancers. Men seek risk assessment for similar reasons to women, but express lower concern for out-of-pocket costs or adverse personal and familial emotional reactions to testing results. Efforts to make cancer risk assessment services more visible and available to men and working individuals (e.g., expanded clinical hours, on-site education/counseling at places of employment, health clubs, etc) may help to increase the identification of high-risk individuals who would benefit from tailored GI prevention education, genetic counseling, and PGT.

Citation Information: Cancer Prev Res 2010;3(1 Suppl):B7.