Abstract A37: Efficient identification of low-income women at high risk for hereditary breast cancer and referral to genetic counseling
Authors: Joseph Galen , Stewart Susan , Lee Robin , Kaplan Celia , Luce Judith , Marquez Titas , Davis Sharon , Pasick Rena J. 
Published: June 2012

Background: For more than a decade, genetic counseling and testing have been used by affluent and insured women in an effort to reduce their risk of hereditary breast cancer. Low-income women have had little if any access to these services or to risk reduction education and outreach where free or low-cost services are available. Integrating a recruitment and referral strategy into an existing statewide phone service used by thousands of low-income women was expected to be an efficient and sustainable model for reaching those with this rare but serious health risk. This study was designed to assess the feasibility of this approach and to determine if low-income women could be successfully connected with existing free genetic counseling and testing services.

Methods: Low income women throughout California access free breast and cervical cancer screening via the state's Cancer Detection Program toll-free phone service known as “Every Woman Counts” (EWC). We developed and pre-tested: i) a brief family history screener for administration to English and Spanish-speaking women from six San Francisco Bay Area Counties (SFBA) who call to request screening referrals (free genetic counseling and testing are available in these languages to women in the SFBA through UCSF); and ii) a referral strategy for use by EWC with high-risk women. A randomized trial with a delayed intervention control is being conducted to test an intervention in which callers identified as potentially at high risk are called back for a baseline survey and then randomized to receive either the offer of an appointment or a mailed brochure with a number to call. A follow-up survey is conducted with all participants two months following randomization. At that time, all women in the control group and the intervention group who have not had counseling are offered a counseling appointment.

Results: To date EWC has identified 1035 eligible (by region and language) callers, of whom 596 (58%) agreed to participate in our study. Of these, 85 (14%) were high risk according to our screener, and so far 72 have been randomized to immediate or delayed referral to genetic counseling. The race/ethnicity of this study sample is: Asian, 9.4%; Black/African American, 10.6%; Hispanic, 23.5%; Native Hawaiian/Pacific Islander, 3.5%; White, 46%; more than one race 3.5%: unknown, 3.5% The immediate referral appears significantly more effective than the mailed brochure in encouraging high-risk women to obtain genetic counseling. Out of the 72 randomized, 26 (36%) have received counseling. Of these, 13 (18%) were in the intervention group and counseled during the two-month intervention period, compared with only 3 (4%) in the control group who were counseled during the intervention period.

Conclusions: It is feasible to identify low-income women at risk for hereditary breast cancer among callers to a statewide cancer screening phone line, and a brief phone intervention is effective in connecting them with free genetic counseling.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A37.