{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T15:54:11Z","timestamp":1758815651514,"version":"3.37.3"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,7]],"date-time":"2019-02-07T00:00:00Z","timestamp":1549497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite a growing body of literature describing the geographic and sociodemographic distribution of cancer genetic testing, work focused on these domains in cancer genetic counseling is limited. Research describing the epidemiology of cancer genetic counseling has mainly focused on isolated populations, a single gender (women) and a single condition (hereditary breast and ovarian cancer). Study findings to date are contradictory, making it unclear what, if any, disparities in receipt of cancer genetic counseling exist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Utilizing the 2015 National Health Interview Survey (NHIS)\u2014a cross\u2010sectional, in person interview survey collecting self\u2010reported health data for the US population\u2014geographic and sociodemographic factors were compared between those receiving genetic counseling and the national sample. Bivariate analysis and subsequent multivariable logistic regression were performed with stratification by cancer status (affected\/unaffected). Reason for (eg, doctor recommended) and focus of (eg, breast\/ovarian) genetic counseling were also assessed. To generate nationally representative estimates, all analyses were adjusted for survey weights.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An estimated 4.8 million individuals in the United States had cancer genetic counseling. On bivariate analysis, there were significant differences in proportions undergoing genetic counseling by sex, race\/ethnicity, insurance, citizenship, education, age, and cancer status (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). After adjustment, however, only female sex (Odds Ratio [OR]: 1.78 [95% CI: 1.18\u20102.67]) remained a significant predictor of genetic counseling among the affected. Among the unaffected, female sex (OR: 1.70 [1.30\u20102.21]), non\u2010Hispanic black race (OR: 1.44 [1.02\u20102.05], reference: non\u2010Hispanic white), graduate education (OR: 1.76 [1.03\u20102.98], reference: less than high school), and age (OR: 1.06 [1.01\u20101.11]) predicted higher rates of genetic counseling. An estimated 2.1 million individuals have undergone genetic counseling focused on breast\/ovarian cancer, 1.3 million on colorectal cancer, and 1.4 million on \u201cother\u201d cancers. Of those receiving genetic counseling focused on breast\/ovarian cancer, 3% were male and 97% female (breast cancer alone\u20104% male, 96% female); for colorectal cancer, 49% male and 51% female, and for \u201cother\u201d cancers, 60% male and 40% female. The majority of individuals receiving genetic counseling reported they did so because their doctor recommended it (66%), with smaller proportions describing self (12%), family (10%), or media (5%) influences as the primary reason.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first study to depict the sociodemographic and geographic distribution of cancer genetic counseling at the national level. Despite perceived disparities in access, cancer genetic counseling in the United States appears to be accessed by individuals of diverse racial\/ethnic backgrounds, with various insurance coverage and educational levels, and across a broad range of ages and geographic regions. The only sociodemographic factor that independently predicted receipt of genetic counseling across both the affected and unaffected population was sex. With physician recommendation as the predominant driver for counseling, targeting physician education, and awareness is crucial to utilization.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.1864","type":"journal-article","created":{"date-parts":[[2019,2,8]],"date-time":"2019-02-08T05:12:36Z","timestamp":1549602756000},"page":"1306-1314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Painting a portrait: Analysis of national health survey data for cancer genetic counseling"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3085-0738","authenticated-orcid":false,"given":"Monica H.","family":"Stamp","sequence":"first","affiliation":[{"name":"Center for Clinical Genetics and Genomics Providence St. Joseph Health  Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ora K.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Center for Clinical Genetics and Genomics Providence St. Joseph Health  Los Angeles California"},{"name":"Division of Genetics Providence John Wayne Cancer Institute Santa Monica California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6489-8222","authenticated-orcid":false,"given":"Christopher P.","family":"Childers","sequence":"additional","affiliation":[{"name":"Department of Surgery David Geffen School of Medicine at UCLA Los Angeles California"},{"name":"Department of Health Policy and Management Fielding School of Public Health at UCLA Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly K.","family":"Childers","sequence":"additional","affiliation":[{"name":"Center for Clinical Genetics and Genomics Providence St. Joseph Health  Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.6228"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.5495"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603144"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29010"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aaf6814"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1158\/1940-6207.CAPR-10-0345"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1415979111"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-005-9014-3"},{"key":"e_1_2_7_10_1","unstructured":"Genetic\/familial high\u2010risk assessment: Colorectal; Version 3.2017 [Accessed May 2 2018]. Available fromhttps:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/genetics_colon.pdf."},{"key":"e_1_2_7_11_1","unstructured":"Final Recommendation Statement: BRCA\u2010Related Cancer: Risk Assessment Genetic Counseling and Genetic Testing. U.S. Preventive Services Task Force. December 2013.https:\/\/www.uspreventiveservicestaskforce.org\/Page\/Document\/RecommendationStatementFinal\/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing."},{"key":"e_1_2_7_12_1","unstructured":"Page Cigna2018. Available at:https:\/\/www.cigna.com\/healthcare-professionals\/resources-for-health-care-professionals\/genetic-testing-and-counseling-program. Accessed May 1 2018."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1334-9"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-12-1280"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0004.2003.00112.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-1009-6"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/GIM.0b013e3181ab22aa"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2014.0070"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000078162"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0340"},{"key":"e_1_2_7_21_1","article-title":"Barriers and facilitators for utilization of genetic counseling and risk assessment services in young female breast cancer survivors","volume":"298745","author":"Anderson B","year":"2012","journal-title":"J Cancer Epidemiol"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.14.1729"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-015-3374-7"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.00.4952"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2017.10.015"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1120"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.76.2369"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/cge.12868"},{"key":"e_1_2_7_29_1","unstructured":"National Center for Health Statistics.National Health Interview Survey 2015. Public\u2010use data file and documentation.https:\/\/www.cdc.gov\/nchs\/nhis\/quest_data_related_1997_forward.htm. 2016. Accessed March 21 2018."},{"key":"e_1_2_7_30_1","first-page":"1","article-title":"Design and estimation for the national health interview survey, 2006\u20132015","volume":"165","author":"Parsons VL","year":"2014","journal-title":"Vital Health Stat"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2008.17"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-4098-y"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0271"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9056(17)30301-9"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gim.0000237867.34011.12"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.73.6314"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16918"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcam4.1864","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.1864","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.1864","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.1864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T08:54:23Z","timestamp":1740214463000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.1864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,7]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1002\/cam4.1864"],"URL":"https:\/\/doi.org\/10.1002\/cam4.1864","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"type":"print","value":"2045-7634"},{"type":"electronic","value":"2045-7634"}],"subject":[],"published":{"date-parts":[[2019,2,7]]},"assertion":[{"value":"2018-07-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}