A pilot randomised controlled trial of the feasibility, acceptability and impact of giving information on personalised genomic risk of melanoma to the public

Background: Communication of personalized melanoma genomic risk information may improve melanoma prevention behaviors. Methods: We evaluated the feasibility and acceptability of communicating personalized genomic risk of melanoma to the public and its preliminary impact on behaviors and psychosocial outcomes. One hundred eighteen people aged 22 to 69 years provided a saliva sample and were randomized to the control (nonpersonalized educational materials) or intervention (personalized booklet presenting melanoma genomic risk as absolute and relative risks and a risk category based on variants in 21 genes, telephone-based genetic counseling, and nonpersonalized educational materials). Intention-to-treat analyses overall and by-risk category were conducted using ANCOVA adjusted for baseline values. Results: Consent to participate was 41%, 99% were successfully genotyped, and 92% completed 3-month follow-up. Intervention participants reported high satisfaction with the personalized booklet (mean = 8.6, SD = 1.6; on a 0–10 scale) and genetic counseling (mean = 8.1, SD = 2.2). No significant behavioral effects at 3-month follow-up were identified between intervention and control groups overall: objectively measured standard erythemal doses per day [−16%; 95% confidence interval (CI), −43% to 24%] and sun protection index (0.05; 95% CI, −0.07 to 0.18). There was increased confidence identifying melanoma at 3 months (0.40; 95% CI, 0.10–0.69). Stratified by risk category, effect sizes for intentional tanning and some individual sun protection items appeared stronger for the average-risk group. There were no appreciable group differences in skin cancer–related worry or psychologic distress. Conclusions: Our results demonstrate feasibility and acceptability of providing personalized genomic risk of melanoma to the public. Impact: Genomic risk information has potential as a melanoma prevention strategy. Cancer Epidemiol Biomarkers Prev; 26(2); 212–21. ©2016 AACR.

[1]  J. Garber,et al.  Patient Perceptions of Telephone vs. In-Person BRCA1/BRCA2 Genetic Counseling , 2016, Journal of Genetic Counseling.

[2]  A. Rahm,et al.  Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review , 2016, Front. Oncol..

[3]  T. Marteau,et al.  The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis , 2016, British Medical Journal.

[4]  A. Marshall,et al.  Mediation of improvements in sun protective and skin self‐examination behaviours: results from the healthy text study , 2016, Psycho-oncology.

[5]  M. Crane,et al.  Estimating the economic costs of skin cancer in New South Wales, Australia , 2015, BMC Public Health.

[6]  P. Butow,et al.  Exploring the Potential Emotional and Behavioural Impact of Providing Personalised Genomic Risk Information to the Public: A Focus Group Study , 2015, Public Health Genomics.

[7]  Marko Hočevar,et al.  Genome-wide meta-analysis identifies five new susceptibility loci for cutaneous malignant melanoma , 2015, Nature Genetics.

[8]  Jennifer M. Taber,et al.  Impact of melanoma genetic test reporting on perceived control over melanoma prevention , 2015, Journal of Behavioral Medicine.

[9]  Yuelin Li,et al.  Family risk discussions after feedback on genetic risk of melanoma. , 2015, JAMA dermatology.

[10]  N. Gerry,et al.  Common Genetic Risk for Melanoma Encourages Preventive Behavior Change , 2015, Journal of personalized medicine.

[11]  K.,et al.  Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. , 2015, American journal of preventive medicine.

[12]  S. Rosso,et al.  MITF E318K's effect on melanoma risk independent of, but modified by, other risk factors , 2014, Pigment cell & melanoma research.

[13]  M. Bui,et al.  Contribution of MC1R Genotype and Novel Common Genomic Variants to Melanoma Risk Prediction , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[14]  Gerard J Fitzsimmons,et al.  From the Australian Institute of Health and Welfare , 2014, Communicable diseases intelligence quarterly report.

[15]  R. Lucas,et al.  Measuring Exposure to Solar Ultraviolet Radiation Using a Dosimetric Technique: Understanding Participant Compliance Issues , 2014, Photochemistry and photobiology.

[16]  P. Pharoah,et al.  Public health genomics and personalized prevention: lessons from the COGS project , 2013, Journal of internal medicine.

[17]  J. Barrett,et al.  MC1R genotype as a predictor of early-onset melanoma, compared with self-reported and physician-measured traditional risk factors: an Australian case-control-family study , 2013, BMC Cancer.

[18]  Eric J Topol,et al.  Impact of direct-to-consumer genomic testing at long term follow-up , 2013, Journal of Medical Genetics.

[19]  P. Pharoah,et al.  Public health implications from COGS and potential for risk stratification and screening , 2013, Nature Genetics.

[20]  R. Lucas,et al.  The AusD Study: a population-based study of the determinants of serum 25-hydroxyvitamin D concentration across a broad latitude range. , 2013, American journal of epidemiology.

[21]  K. Glanz,et al.  Melanoma Genetic Testing, Counseling, and Adherence to Skin Cancer Prevention and Detection Behaviors , 2013, Cancer Epidemiology, Biomarkers & Prevention.

[22]  H. Olsson,et al.  Perceptions of genetic research and testing among members of families with an increased risk of malignant melanoma. , 2012, European journal of cancer.

[23]  Dirk Schadendorf,et al.  Skin examination behavior: the role of melanoma history, skin type, psychosocial factors, and region of residence in determining clinical and self-conducted skin examination. , 2012, Archives of dermatology.

[24]  A. Bauman,et al.  Effectiveness of Australia's Get Healthy Information and Coaching Service®: translational research with population wide impact. , 2012, Preventive medicine.

[25]  G. Giles,et al.  MC1R genotypes and risk of melanoma before age 40 years: A population‐based case‐control‐family study , 2012, International journal of cancer.

[26]  F. Barros,et al.  Quality of DNA extracted from saliva samples collected with the Oragene™ DNA self-collection kit , 2012, BMC Medical Research Methodology.

[27]  M. Weinstock Reducing death from melanoma and standards of evidence. , 2012, The Journal of investigative dermatology.

[28]  C. McBride,et al.  Patients’ understanding of and responses to multiplex genetic susceptibility test results , 2012, Genetics in Medicine.

[29]  N. Schork,et al.  Genomic information as a behavioral health intervention: can it work? , 2011, Personalized medicine.

[30]  C. Moore,et al.  Recommendations for Planning Pilot Studies in Clinical and Translational Research , 2011, Clinical and translational science.

[31]  C. McBride,et al.  Skin Cancer Concerns and Genetic Risk Information-Seeking in Primary Care , 2011, Public Health Genomics.

[32]  Gail M Williams,et al.  Reduced melanoma after regular sunscreen use: randomized trial follow-up. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[33]  K. Glanz,et al.  Validity of Self-reported Solar UVR Exposure Compared with Objectively Measured UVR Exposure , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[34]  T. Marteau,et al.  Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours. , 2010, The Cochrane database of systematic reviews.

[35]  Richard Emsley,et al.  Ian R White interventions Mediation and moderation of treatment effects in randomised controlled trials of complex , 2010 .

[36]  D. Elder,et al.  Does MC1R genotype convey information about melanoma risk beyond risk phenotypes? , 2010, Cancer.

[37]  L. Koehly,et al.  The behavioral response to personalized genetic information: will genetic risk profiles motivate individuals and families to choose more healthful behaviors? , 2010, Annual review of public health.

[38]  D. Moher,et al.  CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials , 2010, Journal of pharmacology & pharmacotherapeutics.

[39]  J. Evans,et al.  Telephoned BRCA1/2 Genetic Test Results: Prevalence, Practice, and Patient Satisfaction , 2009, Journal of Genetic Counseling.

[40]  K. Glanz,et al.  Validity of covering-up sun-protection habits: Association of observations and self-report. , 2009, Journal of the American Academy of Dermatology.

[41]  G. Mann,et al.  Genetic testing for melanoma risk: a prospective cohort study of uptake and outcomes among Australian families , 2009, Genetics in Medicine.

[42]  M. Hadders‐Algra,et al.  How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? , 2008, Archives of Disease in Childhood.

[43]  T. Fears,et al.  Agreement Between Diary Records of Time Spent Outdoors and Personal Ultraviolet Radiation Dose Measurements , 2008, Photochemistry and photobiology.

[44]  K. Glanz,et al.  Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. , 2008, Archives of dermatology.

[45]  V. Beral,et al.  Cohort Profile: The 45 and Up Study , 2007, International journal of epidemiology.

[46]  S. Galea,et al.  Participation rates in epidemiologic studies. , 2007, Annals of epidemiology.

[47]  E. Weber,et al.  A Domain-Specific Risk-Taking (DOSPERT) Scale for Adult Populations , 2006, Judgment and Decision Making.

[48]  R. Lyles Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models , 2006 .

[49]  Charles E. McCulloch,et al.  Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models , 2005 .

[50]  J. Aitken,et al.  Attitudes and intentions in relation to skin checks for early signs of skin cancer. , 2004, Preventive medicine.

[51]  H. Wulf,et al.  The wrist is a reliable body site for personal dosimetry of ultraviolet radiation , 2000, Photodermatology, photoimmunology & photomedicine.

[52]  B. Armstrong,et al.  How much melanoma is caused by sun exposure? , 1993, Melanoma research.

[53]  M. Weinstein,et al.  Performance of a Five-Item Mental Health Screening Test , 1991, Medical care.

[54]  S. Buys,et al.  Economic Evaluation Alongside a Clinical Trial of Telephone Versus In-Person Genetic Counseling for BRCA1/2 Mutations in Geographically Underserved Areas. , 2016, Journal of oncology practice.

[55]  R. Croyle,et al.  Theory at a glance: a guide for health promotion practice (Second edition). , 2005 .