Women\u2019s perception, attitudes, and intended behavior towards predictive epigenetic risk testing for female cancers in 5 European countries: a cross-sectional online survey

Odette Wegwarth,Nora Pashayan,Felix G Rebitschek,Martin Widschwendter

doi:10.1186/s12889-019-6994-8

Abstract

BackgroundEpigenetic markers might be used for risk-stratifying cancer screening and prevention programs in the future. Although the clinical utility of consequent epigenetic tests for risk stratification is yet to be proven, successful adoption into clinical practice also requires the public’s acceptance of such tests. This cross-sectional online survey study sought to learn for the first time about European women’s perceptions, attitudes, and intended behavior regarding a predictive epigenetic test for female cancer (breast, ovarian, cervical, and endometrial) risks.Methods1675 women (40–75 years) from five European countries (Czech Republic, Germany, United Kingdom, Italy, Sweden), drawn from online panels by the survey sampling company Harris Interactive (Germany), participated in an online survey where they first received online leaflet information on a predictive epigenetic test for female cancer risks and were subsequently queried by an online questionnaire on their desire to know their female cancer risks, their perception of the benefit-to-harm ratio of an epigenetic test predicting female cancer risks, reasons in favor and disfavor of taking such a test, and their intention to take a predictive epigenetic test for female cancer risks.ResultsMost women desired information on each of their female cancer risks, 56.6% (95% CI: 54.2–59.0) thought the potential benefits outweighed potential harms, and 75% (72.0–77.8) intended to take a predictive epigenetic test for female cancer risks if freely available. Results varied considerably by country with women from Germany and the Czech Republic being more reserved about this new form of testing than women from the other three European countries. The main reason cited in favor of a predictive epigenetic test for female cancer risks was its potential to guide healthcare strategies and lifestyle changes in the future, and in its disfavor was that it may increase cancer worry and coerce unintended lifestyle changes and healthcare interventions.ConclusionsA successful introduction of predictive epigenetic tests for cancer risks will require a balanced and transparent communication of the benefit-to-harm ratio of healthcare pathways resulting from such tests in order to curb unjustified expectations and at the same time to prevent unjustified concerns.

Highlights

Epigenetic markers might be used for risk-stratifying cancer screening and prevention programs in the future
It has been recognized that expressions of cancer-associated genes in the majority of sporadic cancers is controlled by deoxyribonucleic acid (DNA) methylation processes—defined as epigenomics—that can influence gene expression, without causing a permanent alteration in a gene
In the setting of prostate cancer, for example, targeting screening to men at higher than population average risk could reduce the proportion of men likely to be overdiagnosed and, overtreated. [7, 8] Risk prediction models that incorporate epigenetic markers could provide new opportunities for risk stratification in risk-stratified cancer screening and prevention programs. [6]

Summary

Introduction

Epigenetic markers might be used for risk-stratifying cancer screening and prevention programs in the future. The clinical utility of consequent epigenetic tests for risk stratification is yet to be proven, successful adoption into clinical practice requires the public’s acceptance of such tests. Epigenomic regulators are at work nonstop, removing or adding chemical marks that allow for transient gene readouts while blocking them in the minute. Risk factors such as age, reproductive and lifestyle factors, and environmental exposures can trigger alterations in the epigenome, which have been implicated in the development and progression of cancer. [7, 8] Risk prediction models that incorporate epigenetic markers could provide new opportunities for risk stratification in risk-stratified cancer screening and prevention programs. In the setting of prostate cancer, for example, targeting screening to men at higher than population average risk could reduce the proportion of men likely to be overdiagnosed and, overtreated. [7, 8] Risk prediction models that incorporate epigenetic markers could provide new opportunities for risk stratification in risk-stratified cancer screening and prevention programs. [6]

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Conclusion