Interest and Uptake ofMC1RTesting for Melanoma Risk in a Diverse Primary Care Population

Abstract

Importance Germline variants in the MC1R gene are common and confer moderate melanoma risk in those with varied skin types. Approaches to precision skin cancer prevention that include genetic information may promote risk awareness and risk reduction in the general population, including Hispanics. Objective To examine prevalence of interest in and uptake of MC1R testing in the general population and examine patterns across demographic and skin cancer risk factors. Design A randomized controlled trial examined interest in and uptake of MC1R testing. Study participants were randomized to either a usual care condition (NCI skin cancer pamphlet for diverse skin types) or an MC1R test offer. Setting University of New Mexico General Internal Medicine clinics. Participants Participants were registered clinic patients (≥ 6 months) and English or Spanish fluent. Of the N=600 recruited to the overall trial, the current study included those 499 participants randomized to the MC1R test offer (44% non-Hispanic white, 49% Hispanic, 79% female; mean age=54). Intervention Participants were presented with the option to log onto the study website to read three educational modules presenting the rationale, benefits and drawbacks of MC1R testing. Main Outcomes and Measures Main outcomes include website logon (yes vs. no), saliva test kit request (yes vs. no), and saliva test kit return for MC1R testing (yes vs. no). Demographic and skin cancer risk factors were examined as potential predictors of test interest and uptake. Results About half of participants (46%, n=232) elected to learn about MC1R testing by logging onto the website; most that logged on decided to request testing (88%, n=204); and most who requested testing returned the kit (82%, n=167). The strongest predictors of website logon were race/ethnicity and education (non-Hispanic whites and more highly educated were more likely to log on); the strongest predictor of ordering the test was sunburn history. Conclusion and Relevance There were moderately high levels of MC1R test interest and uptake in this diverse sample. Addressing potential barriers to testing may be warranted as genomic information becomes integrated into general population approaches to the precision prevention of skin cancer.

Behavioral and Psychological Outcomes Associated with Skin Cancer Genetic Testing in Albuquerque Primary Care

“…In previous analyses, participants who completed testing reported high levels of interest and engagement in their test feedback results and reported determination to improve sun protection behavior after receiving feedback, and such determination was significantly higher in those who received higher risk feedback, compared to average risk feedback two weeks after test receipt [55]. Those with a sunburn history were more likely to complete testing [69]. It may also be that there are elements of behavioral impact that were not measured in the current study that might ultimately contribute to the personal and health utility of MC1R feedback, such as longer-term behavioral habits, improved engagement and perceived control over sun protection choices.…”

“…As reported previously [69], 1998 primary care patients were approached, 917 (46%) agreed to be screened for eligibility, and of the 726 patients who were eligible for the study, 621 (86%) consented to study participation; 21 did not complete the baseline assessment. Study acceptance was higher in non-Hispanic whites compared to Hispanics, and those with higher (>high school) compared to lower educational attainment (<high school) but did not differ on other demographic factors [69]. Further, those with higher perceived skin cancer risk and those with greater interest in learning about genes were more likely to participate.…”

Peer Review #1 of "Awareness, behavior and attitudes concerning sun exposure among beachgoers in the northern coast of Peru (v0.1)"

“…Thus, interventions could be more targeted and with even more promising results. Finally, we recommend that future studies develop and evaluate the impact of sun-protective interventions, as previous research have shown their potential to promote sun protection in recreational settings (51)(52)(53). Manuscript to be reviewed Manuscript to be reviewed Manuscript to be reviewed 1 Manuscript to be reviewed Manuscript to be reviewed Manuscript to be reviewed Manuscript to be reviewed…”

MC1RVariation in a New Mexico Population

“…Data were collected as part of a randomized controlled trial (NCT03130569) examining interest, uptake, and outcomes associated with an offer of testing for MC1R gene variants associated with increased melanoma risk (10). Study enrollment methods have been described previously (13,14). In brief, 600 participants were recruited from a primary care clinic in Albuquerque, New Mexico (Supplementary Table S1).…”