癌症遗传检测的公众认知度预测因素：对增进参与癌症预防和精准医学的公平性的启示。
Predictors of Population Awareness of Cancer Genetic Tests: Implications for Enhancing Equity in Engaging in Cancer Prevention and Precision Medicine.
机构信息
Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
出版信息
JCO Precis Oncol. 2021 Nov 3;5. doi: 10.1200/PO.21.00231. eCollection 2021.
UNLABELLED
Racial and ethnic disparities in genetic awareness (GA) can diminish the impact of personalized cancer treatment and risk assessment. We assessed factors predictive of GA in a diverse population-based sample to inform awareness strategies and reduce disparities in genetic testing.
METHODS
A cross-sectional study was conducted from July 2019 to August 2019, with the survey e-mailed to 7,575 adult residents in southeastern Pennsylvania and New Jersey. Constructs from National Cancer Institute Health Information and National Trends Survey assessed cancer attitudes or beliefs, health literacy, and numeracy. Characteristics were summarized with mean ± standard deviation for numeric variables and frequency counts and percentages for categorical variables. Comparison of factors by race or ethnicity (non-Hispanic White and non-Hispanic Black) and sex was conducted by -tests, chi-square, or Fisher's exact tests. Multivariate logistic regression models were conducted to identify factors independently predictive of GA.
RESULTS
Of 1,557 respondents, data from 940 respondents (the mean age was 45 ± 16.2 years, 35.5% males, and 23% non-Hispanic Blacks) were analyzed. Factors associated with higher GA included female gender ( < .001), non-Hispanic White ( < .001), college education ( < .001), middle-higher income ( < .001), stronger belief in genetic basis of cancer ( < .001), lower cancer fatalism ( = .004), motivation for cancer information ( < .001), and higher numeracy ( = .002). On multivariate analysis, college education (odds ratio [OR] 1.79; 95% CI, 1.22 to 2.63), higher motivation for cancer information (OR 1.56; 95% CI, 1.17 to 2.09), stronger belief in genetics of cancer (OR 2.21; 95% CI, 1.48 to 3.30), and higher medical literacy (OR 2.21; 95% CI, 1.34 to 3.65) predicted greater GA.
CONCLUSION
This population-based study conducted in the precision medicine era identified novel modifiable factors, importantly perceptions of cancer genetics and medical literacy, as predictive of GA, which informs strategies to promote equitable engagement in genetically based cancer care.
目的：本研究旨在评估一个多样化的人群样本中与基因意识（GA）相关的预测因素，以为提高 GA 意识的策略提供信息，并减少基因检测中的差异。
方法：本研究于 2019 年 7 月至 8 月进行了一项横断面研究，向宾夕法尼亚州东南部和新泽西州的 7575 名成年居民发送了电子问卷调查。国家癌症研究所健康信息和国家趋势调查的研究构建评估了癌症态度或信念、健康素养和计算能力。数值变量采用均数±标准差表示，分类变量采用频数和百分比表示。采用 t 检验、卡方检验或 Fisher 精确检验比较不同种族或族裔（非西班牙裔白人和非西班牙裔黑人）和性别的特征。采用多变量逻辑回归模型确定 GA 的独立预测因素。
结果：在 1557 名受访者中，对 940 名受访者（平均年龄为 45±16.2 岁，35.5%为男性，23%为非西班牙裔黑人）的数据进行了分析。与较高 GA 相关的因素包括女性（ <.001）、非西班牙裔白人（ <.001）、大学学历（ <.001）、中高收入（ <.001）、对癌症遗传基础的强烈信念（ <.001）、较低的癌症宿命论（ =.004）、对癌症信息的获取动机（ <.001）和较高的计算能力（ =.002）。多变量分析显示，大学学历（比值比[OR] 1.79；95%置信区间[CI] 1.22 至 2.63）、更高的获取癌症信息的动机（OR 1.56；95%CI 1.17 至 2.09）、对癌症遗传学的更强信念（OR 2.21；95%CI 1.48 至 3.30）和更高的医学素养（OR 2.21；95%CI 1.34 至 3.65）可预测更高的 GA。
结论：这项在精准医学时代进行的基于人群的研究确定了一些新的可改变的因素，即对癌症遗传学和医学素养的认知，这些因素可预测 GA，为促进公平参与基于基因的癌症治疗提供了策略信息。
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