Table 1.

Integration input of genomics/genetics into international cancer care

International cancer care	Genetics/genomics input with examples	Needs and challenges
Knowledge and communication about FH in families	‘My Family Health Portrait’—US Surgeon General [86] ‘Health Heritage’ [87]	Issues related to family structure, communication, misconceptions, and privacy
Provider knowledge about FH and genetic risk	ASCO cancer genetics education module [88]	Effective training of health care workforce
Integration of FH in care	Provider asks and documents FH CDS in GPM	Time and prioritization
Integration of point of care cancer risk assessment tools	Evidence-based risk assessment tools CaGene in EHRs	Efficient tools to assess risk for clinical decision support
Referral mechanisms for high-risk patients/families	Genetic counseling services FQHCs and PCPs	Shortage of training programs globally TAGC and GPCI
Informed consent	Standards for the protection of participants	International variation Health literacy variation
Molecular testing for hereditary susceptibility syndromes	Genetic testing laboratories with quality standards Risk assessment models	Accessibility and affordability Patent issues Systems-compatible algorithms VUS
Molecular tumor diagnosis	State of art techniques—ability to run whole genome sequencing	Standards in interpretation Accessibility and affordability Evolving knowledge of genome Harmonized nomenclature
Individualized molecularly tailored Rx	Genomic map of tumor biology	Accessibility and affordability Clinical trials mechanism
Cancer registries and public health/heath care organization programs	Inclusion of information on cancer in relatives Screening policies	Resource variation Legal and ethical issues
Survivorship	Access to DNA banking/genetic counseling and testing with integration of FH in palliative medicine [89, 90]	Access to services Integration of evolving genetic understanding throughout lifespan
Nondiscrimination protections	Genetic information nondiscrimination act (GINA)	International discussion and standards
National policies	Genomic test regulation Professional society standards Advisory committees	Legal and regulatory framework Standardization Evaluation measures
Resources	Genetic support groups Multilingual advocacy groups	Culturally and family-centered awareness, discussion, and materials

ASCO, American Society of Clinical Oncology; CDS, clinical decision support; EHR, electronic health record; FH, family health history; FQHCs, federally qualified health centers; GPCI, genetics in primary care institute; GPM, genetically guided personalized medicine; PCP, primary care physicians; Rx, treatment; TAGC, transnational alliance of genetic counselors http://tagc.med.sc.edu/quarterly.asp; VUS, variants of unknown significance.