A B S T R A C T PurposeAlthough guidelines recommend in-person counseling before BRCA1/BRCA2 gene testing, genetic counseling is increasingly offered by telephone. As genomic testing becomes more common, evaluating alternative delivery approaches becomes increasingly salient. We tested whether telephone delivery of BRCA1/2 genetic counseling was noninferior to in-person delivery. Patients and MethodsParticipants (women age 21 to 85 years who did not have newly diagnosed or metastatic cancer and lived within a study site catchment area) were randomly assigned to usual care (UC; n ϭ 334) or telephone counseling (TC; n ϭ 335). UC participants received in-person pre-and post-test counseling; TC participants completed all counseling by telephone. Primary outcomes were knowledge, satisfaction, decision conflict, distress, and quality of life; secondary outcomes were equivalence of BRCA1/2 test uptake and costs of delivering TC versus UC. ResultsTC was noninferior to UC on all primary outcomes. At 2 weeks after pretest counseling, knowledge (d ϭ 0.03; lower bound of 97.5% CI, Ϫ0.61), perceived stress (d ϭ Ϫ0.12; upper bound of 97.5% CI, 0.21), and satisfaction (d ϭ Ϫ0.16; lower bound of 97.5% CI, Ϫ0.70) had group differences and confidence intervals that did not cross their 1-point noninferiority limits. Decision conflict (d ϭ 1.1; upper bound of 97.5% CI, 3.3) and cancer distress (d ϭ Ϫ1.6; upper bound of 97.5% CI, 0.27) did not cross their 4-point noninferiority limit. Results were comparable at 3 months. TC was not equivalent to UC on BRCA1/2 test uptake (UC, 90.1%; TC, 84.2%). TC yielded cost savings of $114 per patient. ConclusionGenetic counseling can be effectively and efficiently delivered via telephone to increase access and decrease costs. J Clin

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Ingestion of tap water is one of the principal exposure pathways for disinfection byproducts (DBPs). One major class of DBPs, trihalomethanes (THM), are highly volatile, and volatilization will tend to lower ingestion exposures. This study quantifies volatilization rates of the four THM species that occur while drinking tap water, specifically, losses during the preparation, storage, and serving of water. A mass transfer model based on two-resistance theory and quiescent conditions is presented, and parametrizations of all variables are provided. Volatilization rate constants are estimated in experiments representing common patterns of tap water consumption, i.e., storage of tap water in pitchers, pouring, and serving in glasses and mugs at temperatures from 4 to 100°C. Predicted and experimental results show comparable loss rates for the four THMs. Observed volatilization rates declined exponentially, as expected, and greatly exceeded model predictions that assumed quiescent conditions in the liquid. Loss rates increased with temperature and mixing that resulted from temperature gradients and air currents. Overall, storage, pouring, and serving of tap water at temperatures below 30°C caused minor (<20%) volatilization of THMs. Rapidly heating water to 60 or 80°C also is not expected to result in significant volatilization. However, volatilization losses approached 75% when water was boiled even for brief periods of time and reached 90% when boiled water was poured and served. For the typical adult who drinks nearly half of their water as hot beverages, volatilization will reduce ingestion exposures of THMs by nearly a factor of 2. To account for these losses, exposure estimates for THMs and other volatile chemicals should separate the consumption of heated and unheated tap water.

Background: Ingestion of inorganic arsenic in drinking water is recognized as a cause of bladder cancer when levels are relatively high (≥ 150 µg/L). The epidemiologic evidence is less clear at the low-to-moderate concentrations typically observed in the United States. Accurate retrospective exposure assessment over a long time period is a major challenge in conducting epidemiologic studies of environmental factors and diseases with long latency, such as cancer.Objective: We estimated arsenic concentrations in the water supplies of 2,611 participants in a population-based case–control study in northern New England.Methods: Estimates covered the lifetimes of most study participants and were based on a combination of arsenic measurements at the homes of the participants and statistical modeling of arsenic concentrations in the water supply of both past and current homes. We assigned a residential water supply arsenic concentration for 165,138 (95%) of the total 173,361 lifetime exposure years (EYs) and a workplace water supply arsenic level for 85,195 EYs (86% of reported occupational years).Results: Three methods accounted for 93% of the residential estimates of arsenic concentration: direct measurement of water samples (27%; median, 0.3 µg/L; range, 0.1–11.5), statistical models of water utility measurement data (49%; median, 0.4 µg/L; range, 0.3–3.3), and statistical models of arsenic concentrations in wells using aquifers in New England (17%; median, 1.6 µg/L; range, 0.6–22.4).Conclusions: We used a different validation procedure for each of the three methods, and found our estimated levels to be comparable with available measured concentrations. This methodology allowed us to calculate potential drinking water exposure over long periods.