Parental Communication With their Children about Cancer Risk and DTC Cascade Genetic Testing: Implications for Genetic Education and Counseling.

Cascade genetic testing for cancer risk can influence relatives' health outcomes, as they may benefit from risk reduction and screening. However, clinical guidelines discourage predictive genetic testing in childhood-including direct-to-consumer (DTC) testing. This study examined high-risk parents' preparation of their children (primarily adolescents and young adults) for cascade genetic testing for adult-onset inherited cancers. Surveys were completed by N = 126 parents with pathogenic variants predisposing to adult-onset inherited cancers included on DTC testing panels. A total of 81% of children were aware of their parents' hereditary cancer predisposition and 62% of parents had discussed their children's participation in cancer genetic testing. Potential risks of DTC testing identified by parents included lack of engagement with clinicians; potential benefits were its usefulness for child/family health and convenience. Parents with older children (B = 0.07, p = < 0.001), greater confidence in using genetic information (B = 0.02, p < 0.05), and who held more favorable opinions about pediatric genetic testing (B = 0.02, p < 0.01) were more likely to make their children aware of their familial cancer risk and discuss cascade testing. Most high-risk parents discuss hereditary cancer and testing options with their older children. Research is needed to enrich understanding of healthcare professionals' roles in navigating the implications of cascade genetic testing choices within the family, including DTC testing.