Multilevel research and the challenges of implementing genomic medicine

J Natl Cancer Inst Monogr. 2012 May;2012(44):112-20. doi: 10.1093/jncimonographs/lgs003.


Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum.

MeSH terms

  • Colorectal Neoplasms, Hereditary Nonpolyposis / diagnosis
  • Colorectal Neoplasms, Hereditary Nonpolyposis / genetics
  • Continuity of Patient Care* / organization & administration
  • Continuity of Patient Care* / standards
  • Continuity of Patient Care* / trends
  • Delivery of Health Care, Integrated* / economics
  • Delivery of Health Care, Integrated* / standards
  • Delivery of Health Care, Integrated* / trends
  • Evidence-Based Medicine
  • Genetic Testing*
  • Genomics*
  • Health Policy
  • Health Services Research / methods
  • Humans
  • Interdisciplinary Communication
  • Medicaid
  • Medicare
  • Mutation
  • Neoplasms / diagnosis*
  • Neoplasms / genetics*
  • Neoplasms / therapy
  • Patient Care Team* / standards
  • Patient Care Team* / trends
  • Physicians / standards
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / trends
  • Precision Medicine
  • Quality of Health Care / standards
  • Quality of Health Care / trends
  • Research Design
  • Translational Research, Biomedical* / methods
  • Translational Research, Biomedical* / organization & administration
  • Translational Research, Biomedical* / standards
  • Translational Research, Biomedical* / trends
  • United States