Abstract B33: Motivating African American women with hereditary breast cancer risk to participate in genetic counseling
Authors: Comer-HaGans DeLawnia , Ramamonjiarivelo Zo , Spencer Shirley , Chukwudozie Beverly , Henderson Vida , Watson Karriem , Balthazar Catherine , Evans Rupert , Winn Robert , Odoms-Young Angela , Hoskins Kent 
Published: February 2019

Background: The emerging precision health paradigm for breast cancer control will base screening and prevention on individual level of risk. An important element of this approach is cancer genetic risk assessment and genetic counseling for women with familial breast cancer risk. Despite a referral from their primary care physician (PCP), prior work from our group demonstrated poor uptake of genetic counseling among African American (AA) women with a family history of breast/ovarian cancer who meet national guidelines for genetic counseling. This is consistent with other reports of poor utilization of BRCA testing among AA women. We found a strong desire among both PCPs and AA women for culturally sensitive educational material tailored to AA women at risk for hereditary breast cancer to help them understand the purpose of genetic counseling. In response to that finding, we are developing an educational animation delivered on a mobile device platform that is designed to motivate AA women to attend genetic counseling. Content for the animation will be informed by constructs from a theoretical model of health behavior and by themes identified in semistructured interviews with women who were recommended for genetic counseling by their PCP in our formative work.

Methods: We conducted key informant interviews with healthy AA women without a personal history of cancer who all met criteria established by the National Comprehensive Cancer Network for genetic counseling based on a family history of breast/ovarian cancer. Potential participants were identified from a cohort of women who participated in an earlier study of cancer genetic risk assessment performed as part of routine care in a Federally Qualified Health Center in Chicago, IL. All potential participants were referred for genetic counseling by their PCP and provided consent for re-contact for future research. Recruitment letters were mailed to all eligible women, followed 2 weeks later by phone contact. The study group includes both women who did and who did not attend the counseling session. The semistructured interview guide was based on constructs from the Integrative Model of Behavioral Prediction (IMBP). Standard qualitative data analysis techniques were used, including an iterative process to develop a codebook and use of 2 coders to analyze each interview transcript. An inductive methodology using a modified version of constant comparative analysis was the key methodologic strategy for analyzing the qualitative interviews data.

Results: A total of 60 AA women who were age 25-69 at the time of the prior study were eligible to participate in the interviews. Eleven of these women (18%) attended a genetic counseling session. The mean age of eligible participants was 45 years; 25% reported either a high school diploma or a GED as their highest level of attained education, and 73% completed some education beyond high school; 55% reported receiving their health insurance from Medicaid; and the majority (70%) reported annual household income of less than $30,000. Of 60 eligible women, 16 (27%) were not available for a recruitment phone call (13 had an invalid address or phone number, 2 declined a recruitment phone call, and 1 moved out of the area). Twenty interviews will be completed by the end of June, 2017, and themes from IMBP constructs that emerge as key motivators of attendance at a genetic counseling session will be reported.

Conclusion: The findings from this study will provide data to inform interventions that will be necessary to ensure that underserved AA women with familial breast cancer risk receive genetic counseling. In the absence of effective interventions to increase utilization of cancer genetic services, the emergence of precision health care is likely to exacerbate cancer disparities in underserved AA communities.

Citation Format: DeLawnia Comer-HaGans, Zo Ramamonjiarivelo, Shirley Spencer, Beverly Chukwudozie, Vida Henderson, Karriem Watson, Catherine Balthazar, Rupert Evans, Robert Winn, Angela Odoms-Young, Kent Hoskins. Motivating African American women with hereditary breast cancer risk to participate in genetic counseling [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B33.