A Genomic Test for Colorectal Cancer Risk: Is This Acceptable and Feasible in Primary Care?

In: Public health genomics, Band 23, Heft 3-4, S. 110-121

Abstract

<b><i>Introduction:</i></b> Genomic tests can predict risk and tailor screening recommendations for colorectal cancer (CRC). Primary care could be suitable for their widespread implementation. <b><i>Objective:</i></b> We aimed to assess the feasibility and acceptability of administering a CRC genomic test in primary care. <b><i>Methods:</i></b> Participants aged 45–74 years recruited from 4 Australian general practices were offered a genomic CRC risk test. Participants received brief verbal information about the test comprising 45 CRC-associated single-nucleotide polymorphisms, before choosing whether to undertake the test. Personalized risks were given to testers. Uptake and knowledge of the genomic test, cancer-specific anxiety (Cancer Worry Scale), psychosocial impact (Multidimensional Impact of Cancer Risk Assessment [MICRA] score), and impact on CRC screening behaviour within 6 months were measured. <b><i>Results:</i></b> In 150 participants, test uptake was high (126, 84%), with 125 (83%) having good knowledge of the genomic test. Moderate risk participants were impacted more by the test (MICRA mean: 15.9) than average risk participants (mean: 9.5, difference in means: 6.4, 95% confidence interval (CI): 1.5, 11.2, <i>p</i> = 0.01), but all scores were low. Average risk participants' cancer-specific anxiety decreased (mean differences from baseline: 1 month −0.5, 95% CI: −1.0, −0.1, <i>p</i> = 0.03; 6 months −0.6, 95% CI: −1.0, −0.2, <i>p</i> = 0.01). We found limited evidence for genomic testers being more likely to complete the risk-appropriate CRC screening than non-testers (41 vs. 17%, odds ratio = 3.4, 95% CI: 0.6, 34.8, <i>p</i> = 0.19), but some mediators of screening behaviour were altered in genomic testers. <b><i>Conclusions:</i></b> Genomic testing for CRC risk in primary care is acceptable and likely feasible. Further development of the risk assessment intervention could strengthen the impact on screening behaviour.