Abstract
The expansion of Multi-Gene Panel Testing (MGPT) has led to increased detection of variants of uncertain significance (VUS) among individuals with personal or family history of cancer. However, having a VUS result can impact on emotional and psychological wellbeing and cause challenges for non-geneticist healthcare providers. The purpose of this mixed methods systematic review was to examine what is currently known about the experiences of individuals with a VUS on genetic testing for inherited cancer susceptibility. The initial search was conducted in June 2020 using PUBMED, CINAHL, Web of Science, and PsychInfo according to the Joanna Briggs methodology for systematic reviews. A total of 18 studies met the inclusion criteria. Studies included in this review identified a range of emotional reactions to a VUS result, a general lack of understanding of a VUS result and its implications, frustration with a lack of healthcare provider knowledge, and a need for clear communication with healthcare providers. This review identified critical gaps in current knowledge to guide genetic counseling praxis, specifically in the knowledge of communication patterns and methods of improving communication with healthcare providers and family members and preferred risk management strategies. This will help to improve the counseling process and the management of care during and after genetic testing.
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References
Bentley AR, Callier S, Rotimi CN (2017) Diversity and inclusion in genomic research: why the uneven progress? J Community Genet 8(4):255–266. https://doi.org/10.1007/s12687-017-0316-6
Brédart A, Kop J-L, Dick J, Cano A, De Pauw A, Anota A, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S (2019) Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study. BMJ Open 9(9):e029926. https://doi.org/10.1136/bmjopen-2019-029926
CDC (2020a). Genetic Testing. https://www.cdc.gov/genomics/gtesting/genetic_testing.htm. Accessed 14 Jun 2022
CDC (2020b). Knowing is Not Enough—Act on Your Family Health History | CDC. https://www.cdc.gov/genomics/famhistory/knowing_not_enough.htm. Accessed 14 Jun 2022
Chern J-Y, Lee SS, Frey MK, Lee J, Blank SV (2019) The influence of BRCA variants of unknown significance on cancer risk management decision-making. J Gynecol Oncol 30(4):e60. https://doi.org/10.3802/jgo.2019.30.e60
Conley CC, Ketcher D, Reblin M, Kasting ML, Cragun D, Kim J, Ashing KT, Knott CL, Hughes-Halbert C, Pal T, Vadaparampil ST (2019) The big reveal: family disclosure patterns of BRCA genetic test results among young Black women with invasive breast cancer. J Genet Couns 2020(29):410–422. https://doi.org/10.1002/jgc4.1196
Culver J, Brinkerhoff C (2013) Variants of uncertain significance in BRCA testing: evaluation of surgical decisions, risk perception, and cancer distress. Clin Genet 2013(84):464–472. https://doi.org/10.1111/cge.12097
Cypowyj C, Eisinger F, Huiart L, Sobol H, Morin M, Julian-Reynier C (2008) Subjective interpretation of inconclusive BRCA1/2 cancer genetic test results and transmission of information to the relatives. Psychooncology 18:209–215. https://doi.org/10.1002/pon.1407
Donohue KE, Gooch C, Katz A, Wakelee J, Slavotinek A, Korf BR (2021) Pitfalls and challenges in genetic test interpretation: an exploration of genetic professionals experience with interpretation of results. Clin Genet 99(5):638–649. https://doi.org/10.1111/cge.13917
Edwards QT, Maradiegue A, Seibert D, Jasperson K (2011) Pre- and postassessment of nurse practitioners’ knowledge of hereditary colorectal cancer: nurse practitioners’ knowledge of hereditary colorectal cancer. J Am Acad Nurse Pract 23(7):361–369. https://doi.org/10.1111/j.1745-7599.2011.00625.x
Elsayegh N, Webster RD, Gutierrez Barrera AM, Lin H, Kuerer HM, Litton JK, Bedrosian I, Arun BK (2018) Contralateral prophylactic mastectomy rate and predictive factors among patients with breast cancer who underwent multigene panel testing for hereditary cancer. Cancer Med 7(6):2718–2726. https://doi.org/10.1002/cam4.1519
Esteban I, Vilaró M, Adrover E, Angulo A, Carrasco E, Gadea N, Sánchez A, Ocaña T, Llort G, Jover R, Cubiella J, Servitja S, Herráiz M, Cid L, Martínez S, Oruezábal-Moreno MJ, Garau I, Khorrami S, Herreros-de-Tejada A, Balmaña J (2018) Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain. Psychooncology 27(6):1530–1537. https://doi.org/10.1002/pon.4686
Federici G, Soddu S (2020) Variants of uncertain significance in the era of high-throughput genome sequencing: a lesson from breast and ovary cancers. J Exp Clin Cancer Res 39(1):46. https://doi.org/10.1186/s13046-020-01554-6
Garcia C (2014) Comparison of risk management strategies between women testing positive for a BRCA variant of unknown significance and women with known BRCA deleterious mutations. Genet Med 16(12):7. https://doi.org/10.1038/gim.2014.48
Giri VN, Obeid E, MPhil SEH, Gross L, Bealin L, Hyatt C, Fang CY, Leader A (2018) Understanding of multigene test results among males undergoing germline testing for inherited prostate cancer: implications for genetic counseling. The Prostate 2013(78):879–888. https://doi.org/10.1002/pros.23535
Ha VTD, Frizzo-Barker J, Chow-White P (2018) Adopting clinical genomics: a systematic review of genomic literacy among physicians in cancer care. BMC Med Genomics 11(1):18. https://doi.org/10.1186/s12920-018-0337-y
Hamilton JG, Long JM, Brandt AC, Brower J, Symecko H, Salo-Mullen EE, Christian SN, Harstad T, Couch FJ, Garber JE, Offit K, Robson ME, Domchek SM (2019) Patients’ medical and psychosocial experiences after detection of a CDH1 variant with multigene panel testing. JCO Precis Oncol 3:1–14. https://doi.org/10.1200/PO.18.00300
Huang P (2019). Mistrust and lack of genetic diversity slow gains in precision medicine. NPR.Org. https://www.npr.org/sections/health-shots/2019/07/25/742736466/mistrust-and-lack-of-genetic-diversity-slow-gains-in-precision-medicine. Accessed 14 Jun 2022
Idos GE, Kurian AW, Ricker C, Sturgeon D, Culver JO, Kingham KE, Koff R, Chun NM, Rowe-Teeter C, Lebensohn AP, Levonian P, Lowstuter K, Partynski K, Hong C, Mills MA, Petrovchich I, Ma CS, Hartman A-R, Allen B, Gruber SB (2019) Multicenter prospective cohort study of the diagnostic yield and patient experience of multiplex gene panel testing for hereditary cancer risk. JCO Precis Oncol 3:1–12. https://doi.org/10.1200/PO.18.00217
Kessels RPC (2003) Patients’ memory for medical information. J R Soc Med 96:219–222
Li S-T, Sun S, Lie D, Met-Domestici M, Courtney E, Menon S, Lim GH, Ngeow J (2018) Factors influencing the decision to share cancer genetic results among family members: an in-depth interview study of women in an Asian setting. Psychooncology 27(3):998–1004. https://doi.org/10.1002/pon.4627
Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, Apostolo J, Kirkpatrick P, Loveday H (2020) Chapter 8: mixed methods systematic reviews. In Aromataris E, Munn Z (eds) JBI Manual for Evidence Synthesis JBI. Available from https://synthesismanual.jbi.global; https://doi.org/10.46658/JBIMES-20-09
Makhnoon S, Garrett LT, Burke W, Bowen DJ, Shirts BH (2019a) Experiences of patients seeking to participate in variant of uncertain significance reclassification research. J Community Genet 10:189–196. https://doi.org/10.1007/s12687-018-0375-3
Makhnoon S, Shirts BH, Bowen DJ (2019b) Patients’ perspectives of variants of uncertain significance and strategies for uncertainty management. J Genet Couns 28(2):313–325. https://doi.org/10.1002/jgc4.1075
Milanese J-S, Wang E (2019) Germline mutations and their clinical applications in cancer. Breast Cancer Manag 8(1):BMT23. https://doi.org/10.2217/bmt-2019-0005
Miron A, Schildkraut JM, Rimer BK, Winer EP, Sugg Skinner C, Futreal PA, Culler D, Calingaert B, Clark S, Kelly Marcom P, Iglehart JD (2000) Testing for hereditary breast and ovarian cancer in the Southeastern United States. Ann Surg 231(5):624–634. https://doi.org/10.1097/00000658-200005000-00002
Nair N, Bellcross C, Haddad L, Martin M, Matthews R, Gabram-Mendola S, Crane B, Meaney-Delman D (2017) Georgia primary care providers’ knowledge of hereditary breast and ovarian cancer syndrome. J Cancer Educ 32(1):119–124. https://doi.org/10.1007/s13187-015-0950-9
NCCN (2020) Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic Version 2.2021. NCCN Clinical Practice Guidelines in Oncology. https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf
NCCN Guidelines Panel (2021) Genetic/Familial High-Risk Assessment: Colorectal. https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf. Accessed 14 Jun 2022
Rahner N, Steinke V (2008) Hereditary cancer syndromes. Deutsches Ärzteblatt. International 105(41):706–714. https://doi.org/10.3238/arztebl.2008.0706
Reid S, Pal T (2020) Update on multi-gene panel testing and communication of genetic test results. Breast J 26(8):1513–1519. https://doi.org/10.1111/tbj.13971
Reid S, Spalluto LB, Lang K, Weidner A, Pal T (2022) An overview of genetic services delivery for hereditary breast cancer. Breast Cancer Res Treat 191(3):491–500. https://doi.org/10.1007/s10549-021-06478-z
Reuter C, Chun N, Pariani M, Hanson‐Kahn A (2019) Understanding variants of uncertain significance in the era of multigene panels: through the eyes of the patient. J Genet Couns 28(4):878–886. https://doi.org/10.1002/jgc4.1130
Richter S, Haroun I, Graham TC, Eisen A, Kiss A, Warner E (2013) Variants of unknown significance in BRCA testing: impact on risk perception, worry, prevention and counseling. Annals Oncol 24:viii69–viii74. https://doi.org/10.1093/annonc/mdt312
Rosenthal ET, Bernhisel R, Brown K, Kidd J, Manley S (2017) Clinical testing with a panel of 25 genes associated with increased cancer risk results in a significant increase in clinically significant findings across a broad range of cancer histories. Cancer Genet 218–219:58–68. https://doi.org/10.1016/j.cancergen.2017.09.003
Solomon I, Harrington E, Hooker G, Erby L, Axilbund J, Hampel H, Semotiuk K, Blanco A, Klein WMP, Giardiello F, Leonard L (2017) Lynch syndrome limbo: patient understanding of variants of uncertain significance. J Genet Couns 26(4):866–877. https://doi.org/10.1007/s10897-017-0066-y
Tan DSW, Mok TSK, Rebbeck TR (2016) Cancer genomics: diversity and disparity across ethnicity and geography. J Clin Oncol 34(1):12. https://doi.org/10.1200/JCO.2015.62.0096
Tsai GJ, Chen AT, Garrett LT, Burke W, Bowen DJ, Shirts BH (2020) Exploring relatives’ perceptions of participation, ethics, and communication in a patient-driven study for hereditary cancer variant reclassification. J Genet Couns 29(5):857–866. https://doi.org/10.1002/jgc4.1215
Van Dijk S, Van Asperen CJ, Jacobi CE, Vink GR, Tibben A, Breuning MH, Otten W (2004) Variants of uncertain clinical significance as a result of BRCA1/2 testing: impact of an ambiguous breast cancer risk message. Genet Test 8(3). https://doi.org/10.1089/gte.2004.8.235
Vos J, Otten W, van Asperen C, Jansen A, Menko F, Tibben A (2008) The counsellee’s’ view of an unclassified variant in BRCA1/2: recall, interpretation, and impact on life. Psychooncology 17(8):822–830. https://doi.org/10.1002/pon.1311
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Danielle Gould and Memnun Seven. The first draft of the manuscript was written by Danielle Gould, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Gould, D., Walker, R., Makari-Judson, G. et al. Experiences of individuals with a variant of uncertain significance on genetic testing for hereditary cancer risks: a mixed method systematic review. J Community Genet 13, 371–379 (2022). https://doi.org/10.1007/s12687-022-00600-4
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DOI: https://doi.org/10.1007/s12687-022-00600-4