{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:20:33Z","timestamp":1774614033663,"version":"3.50.1"},"reference-count":63,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Institutes of Health Research\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t              https:\/\/ror.org\/01gavpb45","award":["#179835"],"award-info":[{"award-number":["#179835"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Hereditary cancer syndromes (HCSs), including BRCA 1\/2-associated hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS), confer substantial lifetime cancer risks, yet adherence to recommended risk-management strategies remains variable. This population-based retrospective cohort study examined cancer prevention practices, outcomes, and predictors of cancer occurrence among 476 BRCA and LS carriers identified through the Provincial Medical Genetics Program in Newfoundland and Labrador, Canada (2001\u20132022). Linked genetic, surgical, screening, and cancer registry data were evaluated, with adherence assessed during two intervals (2018\u20132020 and 2020\u20132022) based on NCCN guidelines. Participants were predominantly female (69%), with a mean age of 48.5 years at genetic testing; nearly 70% of primary cancers were already diagnosed at the time of testing. BRCA carriers demonstrated higher uptake of breast MRI (58\u201361%) and risk-reducing salpingo-oophorectomy (63\u201366%) compared with LS carriers\u2019 colonoscopy uptake (42\u201344%). In univariate analyses, non-adherence during 2018\u20132020 was associated with increased odds of cancer after testing (OR \u2248 4.43, p &lt; 0.001); this remained significant in the multivariate model (OR = 8.70; p = 0.0004). Individuals who did not follow recommended risk-management guidelines had nearly nine times greater odds of developing cancer after genetic testing than those who fully adhered to guidelines. Older age at referral (OR = 1.07\/year, p &lt; 0.001) also increased the odds of developing cancer. Study findings indicate that late referral and pre-existing cancers diminish the preventive impact of guideline-based risk management. System-level initiatives to promote earlier genetic testing, enhance cascade outreach, and strengthen surveillance pathways are needed to optimize cancer prevention and earlier cancer detection in high-risk populations.<\/jats:p>","DOI":"10.3390\/curroncol33040184","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:37:15Z","timestamp":1774532235000},"page":"184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Suboptimal Adherence to Hereditary Cancer Risk Management Guidelines: A Cohort Study of High-Risk Individuals in Newfoundland and Labrador, Canada"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9673-0726","authenticated-orcid":false,"given":"Holly","family":"Etchegary","sequence":"first","affiliation":[{"name":"Population Health and Applied Health Sciences (Clinical Epidemiology), Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0302-8810","authenticated-orcid":false,"given":"Rebecca","family":"Puddester","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5313-4884","authenticated-orcid":false,"given":"Zhiwei","family":"Gao","sequence":"additional","affiliation":[{"name":"Population Health and Applied Health Sciences (Clinical Epidemiology), Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Francis","sequence":"additional","affiliation":[{"name":"Patient Partner, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Warren","sequence":"additional","affiliation":[{"name":"Patient Partner, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7231-251X","authenticated-orcid":false,"given":"T. Nadine","family":"Burry","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Memorial University of Newfoundland, St. John\u2019s, NL A1C 5S7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Seal","sequence":"additional","affiliation":[{"name":"Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"},{"name":"Cancer Care Program, Newfoundland and Labrador Health Services, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Woods","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences, Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathy","family":"Watkins","sequence":"additional","affiliation":[{"name":"Centre for Nursing Studies, Newfoundland and Labrador Health Services, St. John\u2019s, NL A1A 1E5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9923-3320","authenticated-orcid":false,"given":"April","family":"Pike","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Avery","sequence":"additional","affiliation":[{"name":"Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"McGrath","sequence":"additional","affiliation":[{"name":"Gastroenterology, Faculty of Medicine, Memorial University of Newfoundland, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andree","family":"MacMillan","sequence":"additional","affiliation":[{"name":"Provincial Medical Genetics Program, Newfoundland and Labrador Health Services, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6879-6602","authenticated-orcid":false,"given":"Lesa","family":"Dawson","sequence":"additional","affiliation":[{"name":"Gynecologic Cancer Prevention and Survivorship Clinic, Division of Gynecologic Oncology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"pkaa045","DOI":"10.1093\/jncics\/pkaa045","article-title":"Establishing a framework for the clinical translation of germline findings in precision oncology","volume":"4","author":"Dixon","year":"2020","journal-title":"JNCI Cancer Spectr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1038\/nature12981","article-title":"Realizing the promise of cancer predisposition genes","volume":"505","author":"Rahman","year":"2014","journal-title":"Nature"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Garutti, M., Foffano, L., Mazzeo, R., Michelotti, A., Da Ros, L., Viel, A., Miolo, G., Zambelli, A., and Puglisi, F. 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