Aligning Policy to Promote Cascade Genetic Screening for Prevention and Early Diagnosis of Heritable Diseases

Cascade genetic screening is a methodology for identifying and testing close blood relatives of individuals at increased risk for heritable conditions and follows a sequential process, minimizing testing costs and the number of family members who need to be tested. It offers considerable potential for cost savings and increased awareness of heritable conditions within families. CDC-classified Tier 1 genomic applications for hereditary breast and ovarian cancer syndrome (HBOC), Lynch Syndrome (LS), and familial hypercholesterolemia (FH) are recommended for clinical use and support the use of cascade genetic screening. Most individuals are unaware of their increased risk for heritable conditions such as HBOC, LS, and FH. Consistent implementation of cascade genetic screening could significantly increase awareness and prevention of heritable conditions. Limitations to effective implementation of cascade genetic screening include: insufficient genetic risk assessment and knowledge by a majority of healthcare providers without genetics credentials; a shortage of genetic specialists, especially in rural areas; a low rate of reimbursement for comprehensive genetic counseling services; and an individual focus on prevention by clinical guidelines and insurance coverage. The family-centric approach of cascade genetic screening improves prevention and early diagnosis of heritable diseases on a population health level. Cascade genetic screening could be better supported and augmented through changes in health policy.     

A strategy disruption component to retrieval-induced forgetting

Retrieval-induced forgetting refers to a paradoxical occurrence wherein the act of remembering some material disrupts the retrieval of other, related material (see, e.g., M. C. Anderson, R. A. Bjork, & E. L. Bjork, 1994). This effect is generally accounted for in terms of inhibitory processes. Across three experiments, we test the inhibitory account of retrieval-induced forgetting, as well as whether there may be a strategy disruption component to the effect. In our first two experiments, we manipulate which items individuals are cued to recall during retrieval practice and demonstrate that retrieval-induced forgetting can be neutralized when those items do not interfere with the individual's retrieval strategy. In the third experiment, we confirm this finding with a different set of stimuli. These results are inconsistent with a purely inhibitory account of retrieval-induced forgetting, and we discuss implications for inhibition theory and strategy disruption in light of these and other findings.