Hereditary breast and ovarian cancer: risk assessment in minority women and provider knowledge gaps

C ancers are collectively the leading causes of premature death in the United States and their incidence is increasing as the population ages. Breast cancer is the most common of the cancer diagnoses and the second leading cause of cancer death in women in both the US and in the state of Georgia. Ovarian cancer is the ffth leading cause of cancer death and is often diagnosed at more advanced stages. Although multiple factors have been associated with an increased risk of breast and ovarian cancer, family history remains the most signifcant and consistent predictor of cancer risk. Systematic collection of family history, referral of high-risk women to cancer genetic services, and selective genetic testing can identify a mutation in a hereditary cancer gene. When followed by cascade Background The Georgia Breast Cancer Genomics Project identifed minority and underserved women at high risk for hereditary breast and ovarian cancer based on family history. Education, web-based screening, genetic counseling, and testing were provided in public health and primary care settings in accordance with evidence-based recommendations and guidelines. Objectives To assess risk of hereditary breast and ovarian cancer (HBOC) among minority and underserved women, provide genetic services according to evidence-based guidelines, and evaluate provider knowledge of HBOC. Methods The Georgia Department of Public Health established this project through a cooperative agreement with the Centers for Disease Control and Prevention. HBOC screening and genetic services were provided in 13 public health centers and federally qualifed health centers. Staff received training on genetics and risk assessment using the Breast Cancer Genetics Referral Screening Tool (B-RST). Providers and medical residents were surveyed on their knowledge of HBOC. Young women with breast cancer were surveyed on receipt of genetic services. Results More than 5,400 women were successfully screened; 79% identifed as racial/ethnic minorities. 5% of women screened positive on the B-RST, which is consistent with HBOC prevalence; 79% agreed to follow up. 23% met criteria for increased risk of BRCA 1/2 mutation and received genetic counseling and testing. Surveys revealed profound gaps in knowledge among physicians and medical residents and lack of delivery of evidence-based genetic services to survivors. Conclusions The genomics project demonstrated the effcacy of population-based screening to identify high-risk women before they receive a diagnosis of cancer. A high percentage of women who screened positive also completed genetic counseling and testing. Access to the benefts of HBOC management to prevent cancer and decrease mortality among minority and underserved women depends on improvements in knowledge of genetics and evidence-based practice by providers. Funding/sponsorship This project was funded through a cooperative agreement from the Centers for Disease Control and Prevention to the Georgia Department of Public Health from 2011-2014. Nancy M Paris, MS, FACHE, Sheryl GA Gabram-Mendola, MD, MBA, FACS, Alice S Kerber, MN, APRN, ACNS-BC, AOCN, APNG, Jean O’Connor, JD, MPH, DrPH, Barbara E Crane, MN, APRN, Monique L Martin, MPH, CHES, Lucy Brannon Traxler, MD, Roland Matthews, MD, Christopher Parker MBBS, MPH, Rachel Webster, MMSc, CGC, Elizabeth Schmitt, MMSc, CGC, Dana Meaney-Delman, MD, MPH, Navya Nair, MD, MPH, Victoria L Green, MD, JD, MBA, and Cecelia A Bellcross, PhD, MS, CGC