This Program Project Grant proposal addresses personalized medicine - health care targeting medical interventions to patients based on their individual characteristics, particularly their genetics. Our objective is to use an integrated, interdisciplinary approach to obtain evidence about key aspects of the translation of genomic information for breast and colorectal cancer into clinical practice and health policy. Our Program includes four Projects and two Cores with the Specific Aims to: Aim 1: Determine utilization of genomic risk stratification and targeted treatment by using the examples of gene expression profiling (GEP) and HER2/neu testing for trastuzumab (Herceptin(r)) for breast cancer. Aim 2: Develop an understanding of preferences for genomic testing and interventions using the example of Lynch-syndrome screening. Aim 3: Develop a generalized, flexible model for evaluating the cost-effectiveness of personalized medicine and estimate the cost-effectiveness of GEP, HER2/neu testing for trastuzumab, and Lynch syndrome screening using unique data from our Program Projects. Aim 4: Develop an evidence base for translating research findings into practice and policy by collecting and synthesizing data on the clinical applications and the regulatory, policy, and economic impacts of genetically based colorectal and breast cancer interventions. Aim 5: Provide Projects with resources for: conceptualizing, measuring, and investigating population differences;conducting qualitative and quantitative research;identifying and obtaining data sources; coordinating activities;and disseminating findings. The significance of this proposal lies in our goal to establish evidence-based information that will be useful to patients, clinicians, providers, researchers, and policymakers in assessing how personalized medicine can be most beneficial and efficient. Our results will have implications beyond the specific cancers studied, as the issues related to utilization, access, preferences, economics, value, and policy implications are relevant across cancer sites and interventions.