{"doi":"10.1093/jncics/pkae018","title":"Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up","abstract":"PURPOSE: Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. METHODS: We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. RESULTS: At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. CONCLUSION: TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA. TRIAL REGISTRATION: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.","journal":"JNCI Cancer Spectrum","year":2024,"id":467549,"datarank":0.23625691657758321,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.028312762409599592,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.028312762409599592,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":3,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9559,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03326713"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":974944,"name":"Jean A. McDougall","orcid":"0000-0003-3144-4387","position":1,"is_corresponding":false},{"id":298441,"name":"Yong Lin","orcid":"0000-0002-5710-5036","position":2,"is_corresponding":false},{"id":284822,"name":"Shou‐En Lu","orcid":"0000-0002-0916-1842","position":3,"is_corresponding":false},{"id":374490,"name":"Scott T. Walters","orcid":"0000-0003-4074-6141","position":4,"is_corresponding":false},{"id":974945,"name":"Emily Heidt","orcid":"0000-0002-6210-3422","position":5,"is_corresponding":false},{"id":298442,"name":"Antoinette M. Stroup","orcid":"0000-0003-3341-4018","position":6,"is_corresponding":false},{"id":361429,"name":"Lisa E. Paddock","orcid":"0000-0001-5977-843X","position":7,"is_corresponding":false},{"id":975418,"name":"Sherry Grumet","orcid":null,"position":8,"is_corresponding":false},{"id":273929,"name":"Deborah Toppmeyer","orcid":"0000-0002-9378-6094","position":9,"is_corresponding":false},{"id":404263,"name":"Anita Y. Kinney","orcid":"0000-0002-2996-9355","position":10,"is_corresponding":false},{"id":1091200,"name":"Jinghua An","orcid":"0000-0002-1650-3855","position":0,"is_corresponding":true}],"reference_count":55,"raw_metadata":null,"created_at":"2026-07-19T02:05:15.025255Z","pmid":"38490263","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}