Genetic testing for cancer risk can significantly improve the prevention or treatment of hereditary cancers, but studies have shown that people who might have a genetic risk often don't get tested. A collaborative team of researchers have tested a possible solution through a clinical trial aimed at making genetic testing more accessible. The trial, called MAGENTA (Making GENetic Testing Accessible), engaged nearly 4,000 women from all 50 U.S. states. It is the first large, randomized study to assess different combinations of remote pre- and posttest genetic counseling for cancer risk. The results, which were presented by Elizabeth M. Swisher, MD, and colleagues during the ASCO20 Virtual Scientific Program, showed that genetic testing can be provided remotely and that genetic counseling before and after testing can be skipped without causing increased distress to patients undergoing genetic testing from their home (Abstract 1506).
Elizabeth M. Swisher, MD
“The MAGENTA trial results are especially relevant now given the fact that the coronavirus pandemic is necessitating the timely and effective delivery of virtual health-care,” said Dr. Swisher, Director of the Division of Gynecologic Oncology at University of Washington School of Medicine, in a statement. “There are many benefits to this new design, so I do see genetic testing for medical purposes headed in this direction, regardless of the pandemic.”
Study Details
The trial began in 2016 and ended in 2020. All of the women who participated in the trial had a family history of breast or ovarian cancer or had a family member with a known genetic mutation. Each participant underwent genetic testing for 19 genes associated with inherited cancer risk. Testing was done using a saliva kit provided by Color Genomics, which was mailed to each trial participant's home and then returned by standard mail.
Trial participants were split into four groups. In every group, women watched an educational video on genetic testing for cancer risk before completing their test. In the standard group, women had mandatory genetic counseling by phone before and after testing. In the other three groups, women skipped the pretest counseling, the posttest counseling, or both. In all four groups, anyone with a positive test result had genetic counseling delivered by a telephone appointment.
The study recently completed analysis of the first 3-month follow-up survey to determine if the remote counseling methods caused negative feelings such as distress or anxiety for trial participants. Analysis of 12 and 24-month checkup surveys will follow.
3-Month Follow-up Results
Results from the 3-month follow-up survey showed that the electronic genetic education methods were effective and skipping personalized counseling did not increase patients' distress. If applied broadly, this can allow medical practitioners to more efficiently provide genetic testing.
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Furthermore, skipping pre-test counseling resulted in more follow-through in completing the testing than traditional genetic counseling. The approach also increased access by eliminating common barriers associated with scheduling and attending several in-person counseling and testing appointments at a medical center or clinic.
“The majority of individuals meeting the U.S. Preventative Services Task Force guidelines for genetic testing have not received genetic testing or counseling,” said Karen Lu, MD, principal investigator of the study and Professor and Chair of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center, in a statement. “The results of this study demonstrate that using online and remote methods for preventative testing and genetic counseling can be an option to help break down barriers and expand the availability of preventative cancer care.”
Disclosure: The MAGENTA clinical trial was funded by the SU2C-Ovarian Cancer Research Alliance-National Ovarian Cancer Coalition Ovarian Cancer Dream Team. For full disclosures of the study authors, visit coi.asco.org.
