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Randomized trial finds that prostate cancer genetic risk score feedback targets prostate‐specific antigen screening among at‐risk men
Author(s) -
Turner Aubrey R.,
Lane Brian R.,
Rogers Dan,
Lipkus Isaac,
Weaver Kathryn,
Danhauer Suzanne C.,
Zhang Zheng,
Hsu FangChi,
Noyes Sabrina L.,
Adams Tamara,
Toriello Helga,
Monroe Thomas,
McKanna Trudy,
Young Tracey,
Rodarmer Ryan,
Kahnoski Richard J.,
Tourojman Mouafak,
Kader A. Karim,
Zheng S. Lilly,
Baer William,
Xu Jianfeng
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30162
Subject(s) - overdiagnosis , medicine , prostate cancer , prostate specific antigen , randomized controlled trial , oncology , prostate cancer screening , anxiety , cancer , genetic testing , gynecology , family history , cancer screening , psychiatry
BACKGROUND Prostate‐specific antigen (PSA) screening may reduce death due to prostate cancer but leads to the overdiagnosis of many cases of indolent cancer. Targeted use of PSA screening may reduce overdiagnosis. Multimarker genomic testing shows promise for risk assessment and could be used to target PSA screening. METHODS To test whether counseling based on the family history (FH) and counseling based on a genetic risk score (GRS) plus FH would differentially affect subsequent PSA screening at 3 months (primary outcome), a randomized trial of FH versus GRS plus FH was conducted with 700 whites aged 40 to 49 years without prior PSA screening. Secondary outcomes included anxiety, recall, physician discussion at 3 months, and PSA screening at 3 years. Pictographs versus numeric presentations of genetic risk were also evaluated. RESULTS At 3 months, no significant differences were observed in the rates of PSA screening between the FH arm (2.1%) and the GRS‐FH arm (4.5% with GRS‐FH vs. 2.1% with FH: χ 2 = 3.13, P = .077); however, PSA screening rates at 3 months significantly increased with given risk in the GRS‐FH arm ( P = .013). Similar results were observed for discussions with physicians at 3 months and PSA screening at 3 years. Average anxiety levels decreased after the individual cancer risk was provided ( P = .0007), with no differences between groups. Visual presentation by pictographs did not significantly alter comprehension or anxiety. CONCLUSIONS This is likely the first randomized trial of multimarker genomic testing to report genomic targeting of cancer screening. This study found little evidence of concern about excess anxiety or overuse/underuse of PSA screening when multimarker genetic risks were provided to patients. Cancer 2016;122:3564–3575 . © 2016 American Cancer Society