Anticipating dissemination of cancer genomics in public health: A theoretical approach to psychosocial and behavioral challenges

Background: Given the recent sequencing of the human genome, genetic susceptibility information will probably be increasingly useful in the prevention and control of many common diseases, including cancer. Purpose: Although much is known about psychosocial factors related to the impact of cancer genetic testing among high-risk families in specialized clinic settings, much less is known about how genetic susceptibility information may contribute to the health and well-being of the general population. Methods: We present a theoretical synthesis drawn from the health communication and health behavior change traditions to guide research examining psychosocial and behavioral challenges central to dissemination of cancer genomics in public health. Results: These challenges include (a) anticipating individuals' reactions to receiving genetic information that is probabilistic and derived from multiple sources; (b) modeling the influ ence of public communication about genetics on the population; (c) confronting the need to disseminate cancer genomic information through public health channels; and (d) maximizing opportunities to achieve cancer risk reduction across individuals, families, and local environments. Throughout the article, we use melanoma genomics as an example of the issues requiring attention. Conclusions: We hope the model helps shape the psychosocial and behavioral research agenda concerning the impact of cancer genomics outside the high-risk clinic.