Barriers and interventions to improve the uptake of cancer risk management strategies in hereditary cancer syndromes: a narrative review

Risk-reduction guidelines for patients with germline pathogenic variants, such as hereditary breast and ovarian cancer and hereditary non-polyposis colorectal cancer, are effective and significantly reduce mortality when implemented. Despite this, uptake of risk-reduction strategies is notably low, especially among medically under-served populations. Barriers to the completion of cancer surveillance, risk-reducing surgical interventions, and chemoprevention are complex and occur at every level in the health care system. In this narrative review article, systematic, clinical, and patient-level barriers to completion of guidelines are described and outlined. In addition, interventions that have emerged to improve the uptake of these interventions are addressed and evaluated for efficacy. These interventions group in 4 main arenas: technologic platforms, multi-disciplinary clinics, decision aids, and psychological support. We comment on the long-term sustainability of these interventions, particularly, in under-served populations and low- to middle-income countries, and highlight areas of impact. We also outline areas of focus for possible future directions and mechanisms for ensuring interventions are equitable, holistic, and rigorously assessed for efficacy.