Abstract P3-09-11: A genetically underserved community
Authors: Sanders RL , Wilson M 
Published: February 2018

It is estimated 5-10% of breast cancer can be attributed to a hereditary predisposition. By knowing a woman's risk for breast cancer, risk reduction strategies can be discussed. Waco, Texas is an underserved community with the nearest geneticists and genetic counselors 35 miles away. This is a multidisciplinary approach to developing a breast cancer risk assessment and genetic carrier screening program in Waco, Texas.

Program Development The initial pilot was designed as a two-week trial to see what the prevalence of at risk women for breast cancer is in our community. The Breast Center distributed a cancer history questionnaire to all of their patients. The women were scored on the Tyrer-Cuzik Breast Cancer Lifetime Risk Assessment Model and surveyed for family and personal history of cancer. Total patients screened in the Breast Center 619. Of these 63.8% had a personal or family history of cancer and 21.8% meet NCCN 2015 criteria for genetic testing. It was projected a 5.3% mutation carrier status in our population and a 14% high risk breast cancer population (&gt;20% lifetime risk of breast cancer).

Methods As a quality initiative, the Breast Center distributed the screening questionnaire and Tyrer-Cuzik score for each woman. Each questionnaire is assessed by a NP for genetic evaluation per NCCN guidelines Genetic/Familial High-Risk Assessment: Breast and Ovarian v1.2016 and NCCN Genetic/Familial High-Risk Assessment; and Colorectal v.1.2016.Allowing for insurance coverage differences, if the patient meets the above criteria, the patient is offered an appointment with informed consent, and genetic counseling services provided by the NP allowing for testing same day as consultation. This program is ongoing, the results listed began January 4, 2016 and ended December 30, 2016. Total patients seen in Breast Center 11,196. Total patients screened for family history 9,726. Patients with family or personal history was 51%, of that 24% met NCCN genetic testing criteria. Patients tested 316, with 5.7% identified genetic mutations

Identified Positive Gene MutationsGeneNumber of PatientsAssociated riskBRCA12Up to 87% breast cancer; 44% ovarian cancer riskBRCA21Up to 84% breast cancer; 27% ovarian cancer riskMSH61Up to 58% risk of male and 30% female colon cancer, up to 71% endometrial cancerCHEK23Up to 48% risk breast cancer; 9.5% colorectal cancerPALB21Up to 40% breast cancer riskPMS21Up to 20% colorectal cancer risk, up to 15% endometrial cancer riskSMAD41Up to 50% colorectal cancer risk, 21% risk of gastric cancerMUTYH, monoallelic6increased risk of colon cancerRAD51C1increased risk ovarian cancerNBN1increased breast cancer

. Women with a &gt;20% lifetime risk of breast cancer 14%.

Conclusion The first year of the program, demonstrated our patient population has a 5.7% prevalence of mutation detection. In addition, a 7.2% high risk breast cancer prevalence was identified. It is imperative to bring awareness to underserved communities to reduce the risk of cancer. This program was developed to improve access to genetic services and identify high risk individuals in our community. The detection rate for our population in this small pilot was 5.7% which is comparable to expected. This pilot program identifies an important role for interdisciplinary approach to genetic services.

Citation Format: Sanders RL, Wilson M. A genetically underserved community [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-09-11.