Understanding beliefs about hereditary susceptibility for cancer: An analysis of HINTS 2020

Purpose: Cancer is driven by a complex interplay of genes and environment. However, little is known about the public's beliefs about hereditary susceptibility to cancer. This study characterized beliefs about hereditary susceptibility to cancer in a nationally representative survey of US adults. We also identified who is more likely to want to know if they had a genetic predisposition to cancer. Procedures: We analyzed data from the NCI Health Information National Trends Survey (HINTS) 2020 Cycle 5 Wave 4 using SAS 9.4 for weighted survey analysis. Adjusted linear regression models assessed predictors of (1) how much respondents believe genes that are inherited determine whether or not a person will develop cancer and (2) how much respondents would want to know if they had a genetic change that increases their chance of getting cancer (these items were reverse coded). Individuals with a previous cancer diagnosis were excluded. Results: Most respondents (N=3,253) were female (46.9%), non-Hispanic White (57.4%), married (44.4%), and were 46.6 years old (SE=.58). On average, respondents endorsed between “somewhat” and “a lot” for how much hereditary susceptibility determines a person's cancer risk and their desire to know if they had a genetic predisposition to cancer. Respondents believed that hereditary susceptibility to cancer (M=1.8, SE=.02), cardiovascular disease (M=1.8, SE=.02), and diabetes (M=1.8, SE=.02) were similar (p's >.6), but believed hereditary susceptibility to obesity was significantly lower (M=2.2, SE =.02, p<.0001). Individuals with health insurance (versus those who were uninsured, beta = -.42 - -.37, p = .017 - .021) and those who had previously sought cancer information (beta = -.19, p < .001) were more likely to believe that hereditary susceptibility determines a person's cancer risk. Individuals who believe in greater hereditary susceptibility to cancer were more likely to want to know if they had a genetic predisposition to cancer (beta = .14, p = .001). Hispanic (beta = -.25, p = .0098) and non-Hispanic Black (beta = -.47, p < .0001) respondents, and individuals with a family history of cancer (beta = -.20, p = .0051), who previously sought cancer information (beta = -.19, p = .0019), and were less fatalistic (beta = -.08, p = .036) were also more likely to want to know about their genetic predisposition to cancer. Conclusions: Individuals who believe in greater hereditary susceptibility to cancer are more likely to want to be informed if they have a genetic predisposition to cancer. Importantly, Hispanic and Black individuals were more likely than non-Hispanic Whites to want to know about their genetic risk to cancer, which highlights the critical need to overcome barriers related to access and cost and ensure equitable access to genetic testing. Outreach and educational efforts are needed to address fatalistic beliefs and lack of information or misinformation.