Abstract A38: Are breast cancer screening patients with family cancer history directed to genetic counseling/testing?
Authors: Weldon Christine B. , Trosman Julia R. , Dupuy Danielle M. , Roggenkamp Betty , Ganschow Pamela , Schink Julian C. , Murphy Anne Marie 
Published: June 2012

Background: The death rate from breast cancer for black women in Chicago, Illinois is 62% higher than for white women, and is much higher than the U.S. disparity of 41% and the New York City disparity of 27% (Sinai Urban Health Institute, 2010). The Chicago Breast Cancer Quality Consortium, funded by Susan G. Komen for the Cure Foundation, previously collected data from 43 Chicago hospitals identifying significant quality deficits in breast cancer screening and treatment (Chicago Breast Cancer Quality Consortium, 2010). Women with a BRCA1/2 mutation have a significantly higher risk for breast and ovarian cancer. While most primary care physicians are aware of BRCA testing, only a minority follow guidelines for BRCA evaluation (Bellcross CA, et al 2011). Our aim was to examine the collection of personal and family cancer history during breast cancer imaging and the resulting referrals to genetic counseling/testing that are or are not initiated from the breast imaging care process.

Methods: We conducted 113 semi-structured interviews with cross-discipline providers involved in breast cancer screening and care. These interviews were across 26 institutions including 18 community, 4 academic, and 4 public hospitals in the Chicago metro area. Participating institutions provide care to diverse populations. For 22 institution's, African American and Hispanic women comprised more than 50% and for the other 4 institution's more than 30% of the patient population. 10 of the participating community hospitals are classified as low resource. Interviewees included: radiologists, mammography technologists, nurses, surgeons, medical oncologists, internists, administrators, registrars and patient navigators. Interviews were transcribed, thematic analysis was conducted following the framework approach, and statistical analysis was performed using simple frequencies and Fisher's exact test.

Results: All (26/26) institutions ask patients at breast cancer screening about their personal and family breast cancer history. One (1/26) institution had a process to refer breast screening patients with a personal or family history to genetic counseling. 10 institutions (38%) had access to genetic counseling within their organizations. Of institutions with internal access to genetic counseling, 80% (8 of 10) referred diagnosed breast cancer patients with familial or personal history to genetic counseling/testing as compared to 31% (5/16) of institutions that do not have internal access to genetic counseling (p=0.0414).

Conclusions: While all institutions collected personal and family history of breast cancer, only one institution had a process for and regularly referred appropriate high risk breast screening patients to genetic counseling/testing. Several of the breast imaging centers are now considering methods to implement genetic counseling referrals in their screening protocols. The biggest challenge the institutions noted was not having a clear place to send the patients for genetic counseling. Further research is needed to investigate factors of access to genetic counseling and testing for low resource hospitals serving diverse populations, as well as to develop the needed services and care processes for all institutions participating in our Consortium.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A38.