BRCA1/2 testing for genetic susceptibility to cancer after 25 years: A scoping review and a primer on ethical implications

Dafina Petrova is supported by a Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain (MCIN/AEI, JC2019-039691-I, https://doi.org/10.13039/501100011033).Background: Mutations in the genes called BRCA1 and BRCA2 are associated with significantly elevated lifetime risk of developing breast and ovarian cancer. This year marks 25 years since genetic tests for BRCA1/2 mutations became available to the public. Currently, comprehensive guidelines exist regarding BRCA1/2 testing and preventive measures in mutation carriers. As such, BRCA1/2 testing represents a precedent not only in genetic testing and management of genetic cancer risk, but also in bioethics. The goal of the current research was to offer a review and an ethical primer of the main ethical challenges related to BRCA testing. Method: A systematic scoping review was undertaken following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Four databases were searched and 18 articles that met the inclusion criteria were synthetized narratively into a conceptual map. Results: Ethical discussions revolved around the BRCA1/2 gene discovery, how tests are distributed for clinical use, the choice to undergo testing, unresolved issues in receiving and disclosing test results, reproductive decision-making, and culture-specific ethics. Several unique properties of the latest developments in testing circumstances (e.g., incorporation of BRCA1/2 testing in multi-gene or whole genome sequence panels and tests sold directly to consumers) significantly raised the complexity of ethical debates. Conclusions: Multidisciplinary ethical discussion is necessary to guide not only individual decision making but also societal practices and medical guidelines in light of the new technologies available and the latest results regarding psychological, social, and health outcomes in cancer previvors and survivors affected by BRCA mutations.Juan de la Cierva Fellowship from the Ministry of ScienceNational Research Agency of Spain (MCIN/AEI) JC2019-039691-

Obesity as a risk factor in COVID-19: Possible mechanisms and implications

Varios artículos recientes sugieren que la obesidad es un factor de riesgo para una enfermedad más grave por coronavirus. En este artículo se resume la evidencia científica disponible sobre el papel de la obesidad en COVID-19, con especial atención en las personas más jóvenes y los mecanismos biológicos propuestos para explicar tanto el mayor riesgo observado como la posible mayor contagiosidad de esta población. Se consideran varias implicaciones de la pandemia sobre las personas con obesidad, en relación con las posibles dificultades en el manejo de los pacientes ingresados, las implicaciones del confinamiento sobre el control y tratamiento de la obesidad, y el estigma que sufren estas personas por su condición, y que puede verse aumentado si se confirma la relación de la obesidad con COVID-19. Comprender el papel de la obesidad en COVID-19 debería ser una prioridad de salud pública, dada la alta prevalencia de esta condición en nuestro país.Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country

Cancer awareness in older adults: Results from the Spanish Onco-barometer cross-sectional survey

Background: About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived bar riers among older adults. Objectives: The goal of the current research was to investigate personal characteristics, perceived barriers, and be liefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. Design: Descriptive cross-sectional study. Participants: Participants were 1213 older adults (≥65 years old) from the representative national Onco barometer survey conducted in 2020 in Spain. Methods: Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Span ish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews. Results: Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was lim ited among males and older individuals. Respondents from lower socio-economic background recognized fewer can cer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and be liefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%–75%]), about what the doctor might find (21% increase [3%–43%]) and not having enough time to go to the doctor (30% increase [5%–60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%–33%]). Conclusions: These results suggest that older adults could benefit from interventions informing them about how to re duce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. Study registration: Not registered.Cancer Observatory of the Spanish Association against Cancer (Asociacion Espanola contrael Cancer)Cancer Epidemiological Surveillance Subprogram (VICA) of the CIBER of Epidemiology and Public Health, Carlos III Health Institute, Madrid, SpainSpanish State Research Agency (MCIN/AEI) JC2019-039691-

Health professionals prefer to communicate risk-related numerical information using "1-in-X" ratios

Previous research showed that format effects such as the “1-in-X” effect – whereby “1-in-X” ratios lead to a higher perceived probability than “N-in-N*X” ratios – alter perceptions of medical probabilities. We do not know, however, how prevalent this effect is in practice – whether health professionals often use “1-in-X” ratios. We assembled four different sources of evidence, involving experimental work and corpus studies, to examine the use of “1-in-X” and other numerical formats quantifying probability. Our results revealed that the use of “1-in-X” ratios is prevalent and that health professionals prefer this format compared with other numerical formats (i.e., the “N-in-N*X”, %, and decimal formats). In Study 1, UK family physicians preferred to communicate prenatal risk using a “1-in-X” ratio (80.4%, n = 131) across different risk levels and regardless of patients’ numeracy levels. In Study 2, a sample from the UK adult population (n = 203), reported that most GPs (60.6%) preferred to use “1-in-X” ratios compared with other formats. In Study 3, “1-in-X” ratios were the most commonly used format in a set of randomly sampled drug leaflets describing the risk of side effects (100%, n = 94). In Study 4, the “1-in-X” format was the most commonly used numerical expression of medical probabilities or frequencies on the UK’s NHS website (45.7%, n = 2,469 sentences). The prevalent use of “1-in-X” ratios magnifies the chances of increased subjective probability. Further research should establish clinical significance of the “1-in-X” effec

Health professionals prefer to communicate risk-related numerical information using “1-in-X” ratios

Previous research showed that format effects such as the “1-in-X” effect – whereby “1-in-X” ratios lead to a higher perceived probability than “N-in-N*X” ratios – alter perceptions of medical probabilities. We do not know, however, how prevalent this effect is in practice – whether health professionals often use “1-in-X” ratios. We assembled four different sources of evidence, involving experimental work and corpus studies, to examine the use of “1-in-X” and other numerical formats quantifying probability. Our results revealed that the use of “1-in-X” ratios is prevalent and that health professionals prefer this format compared with other numerical formats (i.e., the “N-in-N*X”, %, and decimal formats). In Study 1, UK family physicians preferred to communicate prenatal risk using a “1-in-X” ratio (80.4%, n = 131) across different risk levels and regardless of patients’ numeracy levels. In Study 2, a sample from the UK adult population (n = 203), reported that most GPs (60.6%) preferred to use “1-in-X” ratios compared with other formats. In Study 3, “1-in-X” ratios were the most commonly used format in a set of randomly sampled drug leaflets describing the risk of side effects (100%, n = 94). In Study 4, the “1-in-X” format was the most commonly used numerical expression of medical probabilities or frequencies on the UK’s NHS website (45.7%, n = 2,469 sentences). The prevalent use of “1-in-X” ratios magnifies the chances of increased subjective probability. Further research should establish clinical significance of the “1-in-X” effect

Feeling the Numbers: On the Interplay Between Risk, Affect, and Numeracy

ABSTRACT People overweigh small and underweigh large risks, resulting in probability weighting functions with an inverted S-shape. This bias is stronger for affect-rich outcomes: For two outcomes of the same monetary value, people are less sensitive to probability variation for affect-rich than for affect-poor outcomes (e.g., winning a $100 voucher toward a romantic dinner versus an electricity bill). In the current research, we investigated the interactive influence of affect and cognitive skills on probability weighting. Participants decided about buying insurance against the loss of an object, given various probabilities of loss. The description of the object was neutral, affect-rich, or affect-rich followed by an affective reappraisal task. The reappraisal task consisted of thinking about effective coping strategies and possible positive consequences of the loss. We also investigated the effect of numeracy on probability weighting. In particular, we investigated whether people have different affective responses to risks depending on their numerical abilities. Participants showed more overweighting of small probabilities for an affect-rich than for a neutral outcome. This effect was mediated by fear. When participants were given the opportunity to reappraise the loss of the affect-rich object, the effect disappeared. After reappraisal, participants' decisions were influenced by both fear and hope and were more in line with expectations based on normative models. The latter applied in particular to participants who had higher numeracy; they showed more emotional sensitivity to risks and assigned weights closer to linearity. Implications for the role of emotions and numeracy in risk communication are discussed

Who does what the cardiologist recommends? Psychosocial markers of unhealthy behavior in coronary disease patients

Patients diagnosed with coronary heart disease should follow lifestyle recommendations that can reduce their cardiovascular risk (e.g., avoid smoking). However, some patients fail to follow these recommendations and engage in unhealthy behavior. With the aim to identify psychosocial factors that characterize patients at high risk of repeated cardiovascular events, we investigated the relationship between social support, mental health (coping, self-esteem, and perceived stress), and unhealthy behavior. We conducted a cross-sectional study of 419 patients recently diagnosed with coronary heart disease (myocardial infarction or angina) who participated in the National Health Survey in Spain (2018). Unhealthy behaviors were defined according to the European Guidelines on cardiovascular disease prevention. Only 1% of patients reported no unhealthy behaviors, with 11% reporting one, 40% two, 35% three, and 13% four or more unhealthy behaviors. In multiple regression controlling for demographic and traditional risk factors, mental health was the only significant psychosocial factor, doubling the odds of accumulated unhealthy behaviors, OR(high vs. low) = 2.03, 95% CI [1.14, 3.64]. Mental health was especially strongly related to unhealthy behavior among patients with obesity, OR(high vs. low) = 3.50, 95% CI [1.49, 8.45]. The relationship between mental health and unhealthy behaviors suggests that a large proportion of patients may not adhere to lifestyle recommendations not because they purposefully choose to do so, but because they lack coping skills to maintain the recommended healthy behaviors. Low mental well-being may be especially detrimental for behavior change of patients with obesity.Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Using Foucauldian Discourse Analysis to Analyze Young Women’s Constructions of the Human Papillomavirus Vaccine

This case study introduces the reader to Foucauldian discourse analysis (FDA) as applied to a cross-cultural project around young women’s constructions of the Human Papillomavirus (HPV) vaccine. We introduce common qualitative research approaches in psychology. We discuss two main types of Discourse Analysis in psychology and why a Foucauldian discourse analysis was adopted here. In this case we examine examples of our data according to Carla Willig’s (2008) approach to Foucauldian discourse analysis using six stages: discursive constructions, discourses, action orientation, positionings, practice and subjectivity. Finally, we consider the main limits and strengths with a Foucauldian discourse analysis

Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews

High resolution study of social inequalities in cancer (HiReSIC), Spanish Association against Cancer (AECC) (PROYE20023SANC). Cancer Epidemiological Surveillance Subprogram (VICA) of the CIBERESP, Health Institute Carlos III, Madrid, Spain. Dafina Petrova is supported by a Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain (MCIN/AEI, JC2019-039691-I, http://doi.org/10.13039/501100011033, accessed on 4 October 2021).In the past decade, evidence has accumulated about socio-economic inequalities in very diverse lung cancer outcomes. To better understand the global effects of socio-economic factors in lung cancer, we conducted an overview of systematic reviews. Four databases were searched for systematic reviews reporting on the relationship between measures of socio-economic status (SES) (individual or area-based) and diverse lung cancer outcomes, including epidemiological indicators and diagnosis- and treatment-related variables. AMSTAR-2 was used to assess the quality of the selected systematic reviews. Eight systematic reviews based on 220 original studies and 8 different indicators were identified. Compared to people with a high SES, people with a lower SES appear to be more likely to develop and die from lung cancer. People with lower SES also have lower cancer survival, most likely due to the lower likelihood of receiving both traditional and next-generation treatments, higher rates of comorbidities, and the higher likelihood of being admitted as emergency. People with a lower SES are generally not diagnosed at later stages, but this may change after broader implementation of lung cancer screening, as early evidence suggests that there may be socio-economic inequalities in its use.High resolution study of social inequalities in cancer (HiReSIC), Spanish Association against Cancer (AECC) PROYE20023SANCCancer Epidemiological Surveillance Subprogram (VICA) of the CIBERESP, Health Institute Carlos III, Madrid, SpainJuan de la Cierva Fellowship from the Ministry of ScienceNational Research Agency of Spain (MCIN/AEI) JC2019-039691-

The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study

Evidence on the impact of diet, alcohol, body-mass index (BMI), and physical activity on mortality due to cancer and other cancer-related outcomes is still scarce. Herein, we reviewed the contribution of the European Prospective Investigation into Cancer and Nutrition (EPIC) study to the current state of the art on the role of these factors in cancer mortality. We identified 45 studies using a rapid systematic review methodology. Dietary factors associated with reduced cancer mortality included raw vegetable intake; dietary fiber intake; the Mediterranean diet; other dietary scores; other diet patterns including low meat eaters, vegetarians/vegans, or fish eaters; dietary intake (or biomarkers) of some vitamins (e.g., vitamin D, vitamin K2, or Vitamin C); and intake of lignans. Physical activity and following healthy lifestyle recommendations also reduced cancer mortality risk. In contrast, dietary factors associated with higher cancer mortality risk included poor diet quality, consumption of alcohol and soft drinks including juice, and, to a lesser extent, intake of some fatty acids. Excess weight and obesity also increased the risk of cancer mortality. The EPIC study holds valuable information on diet and lifestyle factors and offers a unique opportunity to identify key diet-related factors for cancer mortality prevention