Context
This systematic review aims to (1) characterize strategies used to identify individuals
at increased risk for hereditary breast and ovarian cancer syndrome and Lynch syndrome
outside of oncology and clinical genetic settings, (2) describe the extent to which
these strategies have extended the reach of genetic services to underserved target
populations, and (3) summarize indicators of the potential scalability of these strategies.
Evidence acquisition
Investigators searched PubMed, EMBASE, and PsycINFO for manuscripts published from
October 2005 to August 2019. Eligible manuscripts were those published in English,
those that described strategies to identify those at risk for hereditary breast and
ovarian cancer syndrome or Lynch syndrome, those implemented outside of an oncology
or genetic specialty clinic, and those that included measures of cancer genetic services
uptake. This study assessed strategies used to increase the reach of genetic risk
screening and counseling services. Each study was evaluated using the 16-item quality
assessment tool, and results were reported according to the PRISMA guidelines.
Evidence synthesis
Of the 16 eligible studies, 11 were conducted in clinical settings and 5 in public
health settings. Regardless of setting, most (63%, 10/16) used brief screening tools
to identify people with a family history suggestive of hereditary breast and ovarian
cancer syndrome or Lynch syndrome. When reported, genetic risk screening reach (range
=11%–100%) and genetic counseling reach (range =11%–100%) varied widely across studies.
Strategies implemented in public health settings appeared to be more successful (median
counseling reach=65%) than those implemented in clinical settings (median counseling
reach=26%). Most studies did not describe fundamental components relevant for broad
scalability.
Conclusions
Efforts to expand cancer genomic services are limited outside of traditional oncology
and genetic clinics. This is a missed opportunity because evidence thus far suggests
that these efforts can be successful in expanding the reach of genetic services with
the potential to reduce health inequities in access. This review highlights the need
for accelerating research that applies evidence-based implementation strategies and
frameworks along with process evaluation to understand barriers and facilitators to
scalability of strategies with high reach.
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Article Info
Publication History
Published online: November 07, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
