Regarding the Yin and Yang of Precision Cancer-Screening and Treatment: Are We Creating a Neglected Majority?

• Type of Material: Article
• Authors: Colleen McBride, Emory University; Yue Guan, Emory University; Jennifer L. Hay, Mem Sloan Kettering Canc Ctr
• Language: English
• Date: 2019-11-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph16214168
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• Volume: 16
• Issue: 21
• Grant/Funding Information: This research received no external funding.
• Keywords: Environmental Sciences & Ecology; HEREDITARY BREAST; tumor testing for targeted cancer therapies; UNKNOWN SIGNIFICANCE; CLINICAL-TRIAL; Public, Environmental & Occupational Health; germline testing for hereditary cancer syndromes; WOMEN; MUTATIONS; Science & Technology; VARIANTS; PARTICIPANTS; HIGH-RISK; precision cancer screening and treatment; RECLASSIFICATION; negative results; population-based family history screening; Environmental Sciences; health communication; Life Sciences & Biomedicine; MELANOMA
• Research Categories: Health Sciences, Oncology

Abstract

In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of “positive” screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive “negative” results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin–yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a “neglected majority”. This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments.