Public attitudes towards cascade genetic screening in the United States

Introduction After a patient receives genetic test results that indicate an actionable health condition, cascade genetic screening (CGS) is the process of evaluating the patient’s relatives for a potentially elevated genetic risk of disease. The United States (US) primarily relies on patients to communicate with their relatives, resulting in suboptimal rates of risk communication, familial genetic testing uptake, and risk-reducing interventions. There is ongoing debate about whether and how best to inform relatives of a potentially increased genetic risk. Methods We conducted a nationally representative survey of US adults to assess attitudes toward informing at-risk relatives, acceptability of system-mediated communication, and preferences for the patient’s role in risk communication. Results Respondents (n=2,056) overwhelmingly supported informing relatives about their genetic risk across condition types, with minimal disagreement (<10%) about a relative’s right to know this information. Most agreed (>45% agreed; >30% strongly agreed) they would want to decide for themselves whether their results are shared, though many favorably viewed doctor-supported communication. Direct clinician contact was acceptable (37.4%) or totally acceptable (11.5%) with patient permission but rarely acceptable without consent. Conclusion Findings indicate strong public support for sharing genetic risk information within families, alongside clear expectations for patient consent, to guide CGS implementation in the US.