Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing

Deborah Cragun, Anita Y. Kinney, Tuya Pal

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Introduction: DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered: NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert commentary: As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.

Original languageEnglish (US)
Pages (from-to)57-70
Number of pages14
JournalExpert Review of Molecular Diagnostics
Issue number1
StatePublished - Jan 2 2017
Externally publishedYes

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Molecular Medicine
  • Molecular Biology
  • Genetics


  • Genetic testing
  • health disparities
  • inherited cancer
  • multi-gene panel testing
  • next-generation sequencing


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