MULTIPLE RISKS, DECISIONS & BEHAVIORS IN THE GENOMIC ERA

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This proposal is for advanced training and mentored researchfor Dr. Karen Hurley to become an independent behavioral investigator in hereditary cancer risk. It addresses two challenges posed by the genomic revolution: 1) accounting for multiple, interrelated risk-reducing behavior outcomes in the same person, and 2) accounting for individual variation in the relations between predictor variables and behavioral outcomes. Hereditary syndromes often confer risk to several organs at once, yet studies usually assess one screening outcome at a time. Similarly, psychosocial factors are often analyzed as independent predictors; yet within a given person they are interdependent. Developing new assessment and statistical strategies to understand how patients process complex information, and to analyze interrelated behavioral outcomes, will enhance the accuracy and clinical utility of researchfindings. Study 1will assess longitudinal patterns of adherence (full, partial or none) to comprehensive, multi-organ screening guidelines in HNPCC patients. Cluster analysis will yield a taxonomy of perceived/risk worry types (e.g., selective worry about one type of cancer vs. pervasive worry) that will be used to predict trajectories of adherence over time. In Study 2, BRCA1/2 carriers will be offered computer-based genetic education for two low penetrance cancer risk alleles (RAD51 amplifies BRCA-related risk; APCI1307K indicates colon cancer risk). We will assess genetic testing uptake levels, and explore patterns of relations between predictor variables using automatic interaction detection (AID). We aim to identify groups of patients with different counseling needs, and to examine the differential impact of counseling on satisfaction, distress, and adherence to risk reduction in these groups. The training plan supports the proposed research with coursework in cancer genetics, genetic epidemiology, molecular biology and advanced statistics (latent class analysis, growth curve analysis, hierarchical linear models, and automatic interaction detection). The long-term goal is promote cancer prevention and control efforts in hereditary cancer syndromes by increasing adherence to health-protective behaviors in high risk individuals; however, the research methods developed here may be applied to average risk individuals who receive multiple recommendations for screening (e.g., women over 50 undergoing routine breast, colorectal, cervical, and skin cancer surveillance).