Title: Conceptualising the impact of genetic testing on cancer disparities in the USA

Authors: Ninez A. Ponce, Aimee Afable-Munsuz, Robert J. Nordyke

Addresses: UCLA Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA. ' University of California, San Francisco, 3333 California Street, Suite 265, Box 0613, San Francisco, CA 94143, USA. ' UCLA Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA

Abstract: Testing for germ-line mutations offers a predictive tool of hereditary cancer risk with the promise of future benefits to the US healthcare system and its consumers. Based on the few studies on genetic testing for cancer, awareness and uptake appear to be lower among racial/ethnic minorities. The sources of variation need to be understood for ethical reasons and for more successful technology diffusion in the broader population. We conceptualise a framework for the impact of genetic testing on disparities, as defined by the 2003 Institute of Medicine report on unequal treatment. We further extend this framework by discussing the bi-directional process of immigrant adjustment into a host country. Overall, we argue that genetic testing operating under the prevailing healthcare system will widen disparities, adverse effects of discrimination by providers and insurers will become more pronounced, but increased understanding of acculturation|s effect on immigrants may promote more effective consumption of genetic testing and diffusion of awareness.

Keywords: acculturation; cancer risk; genetic testing; racial minorities; ethnic minorities; disparities; genetics; healthcare technology; hereditary cancer; USA; United States; unequal treatment; immigrant adjustment; discrimination; awareness.

DOI: 10.1504/IJHTM.2007.013522

International Journal of Healthcare Technology and Management, 2007 Vol.8 No.5, pp.536 - 548

Published online: 03 May 2007 *

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