Genetic Testing for Cancer Risk: A Population Survey on Attitudesand Intention

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Abstract
Objective: Genetic testing for cancer risk will shortly enter medical practice. Our intent was to increase the understanding of the public’s attitudes towards and potential demand for genetic testing. Methods: We conducted a random-digit-dial survey of 1,450 adults in Washington State to assess the public’s attitudes toward genetic testing for cancer risk and to investigate correlates of intention to be tested for breast cancer risk (women) and prostate cancer risk (men). No specific genes were mentioned, as the intent of the survey was to understand the general interest in screening for genetic risks. The survey addressed familiarity with genetic testing, intention to be tested for breast or prostate cancer risk (when tests become available), benefits and risks associated with genetic tests, and who should have access to test results. Results: Most respondents expressed the intention to be tested for breast or prostate cancer risk (women 76%, men 83%). Most women (83%) and men (74%) would give the results to their primary care physician, but fewer believed that the test results should be available to their employer (women 5%, men 9%), their health insurer (women 32%, men 31%), or family members (women 42%, men 43%). Over 60% worried that discrimination could arise from genetic testing. Correlates of intention to be tested for breast cancer (women) included a family history of breast cancer, lower education, poor health, a history of mammography screening, and more physician visits in the past year. Among men, correlates of intention to test for prostate cancer included higher income, previous cancer diagnosis, a history of PSA screening, and more physician visits in the past year. Respondents who strongly believed in the benefits of genetic testing, who perceived themselves at greater risk for having a gene that increases risk, or who were less worried about discrimination expressed greater intent to be tested. Conclusions: Our survey suggests that the demand for genetic tests for cancer risk may be high, although confidentiality of test results is a major concern. Health care providers, genetic counselors, and research institutions should prepare strategies and policies for genetic testing and counseling as these tests enter general medical practice.