Inequities in Genetic Testing for Hereditary Breast Cancer: Implications for Public Health Practice
Notice bibliographique
Résumé
Background and context: The Ontario Breast Screening Program for women with a genetic predisposition to breast cancer is 1 of the first international models of a government-funded public health service that offers systematic genetic screening to women at a high-risk of breast cancer. However, since the implementation of the program in 2011, enrolment rates have been lower than anticipated. While there may be several reasons for this to happen, it does call into consideration the 'inverse equity law', whereby the more advantaged in society are the first to participate and benefit from universal health services. An outcome of this phenomenon is an increase in the health divide between those that are at a social advantage vs those that are not. Aim: Using an intersectionality lens this review illuminates the role of the social determinants of health and social identity in creating possible barriers in the access to genetic screening for hereditary breast cancer, and the implications for public health practice in recognizing and ameliorating these differences. Strategy/Tactics: Although it remains too early to understand the exact cause for underenrolment in the OBSP high-risk screening program, this review serves to illuminate how screening programs that are used as targeted interventions to improve health outcomes must take into consideration the complexities associated with utilization and need across the entire population. A failure to do so may further disenfranchise socially disadvantaged individuals and widen the health equity gap that currently exists between population groups based on social location. Program/Policy process: The Ontario Breast Screening Program (OBSP) for High Risk Women is funded by the government; therefore, financial barriers in terms of access to care do not exist for individuals seeking screening. Despite this, the program has had low levels of enrolment based on their population targets (Cancer Care Ontario, 2012). Outcomes: While access to health care services is an important social determinant of health (Whitehead, 1992), the structure and design of health services can render them structurally unavailable and socially inacceptable to certain population groups (Gilson et al., 2007). Indeed, recent studies clearly demonstrate how socially disadvantaged individuals, such as those with lower levels of education, and those from ethnic minority groups consistently underuse health services despite the lack of a financial barrier to care (Maddison, 2011). What was learned: The way in which genetic testing is both accessed and used follow similar trends, such that higher levels of both income and education correlate with an increased awareness of genetic testing, a greater likely hood of receiving referrals for genetic testing, appropriateness of genetic counseling and the final decision to proceed with genetic testing.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,038 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,006 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».