Abstract A35: Barriers to cancer genetic risk assessment in the border region of south Texas
Authors: Mette Lindsey , Torres Ivette , Saldivar Anna Maria Pulido , Poullard Natalie , Tomlinson Gail 
Published: October 2015

Abstract
Historically, low- and middle-income countries have lower breast cancer rates than more economically developed countries. Yet, as these countries adopt a more Westernized lifestyle their populations face growing rates of heart disease, depression, diabetes, and cancer. The Rio Grande Valley of south Texas is home to a rapidly growing minority population. Since 2000, Cameron, Hidalgo, and Webb counties in South Texas have experienced population growth rates of 24.5%, 43.3%, and 35.9%, respectively1. Residents of these counties, located along the United States-Mexican border, are largely Hispanic (88.5% - 95.3%) and predominantly of Mexican descent, with more than one quarter born outside the U.S. Approximately one-third of the population lives below the poverty line and adult illiteracy levels approach 50%2. Colonias - small communities comprised of immigrants along the border - often lack basic necessities, such as electricity, plumbing, and safe housing. There are 958 registered colonias in Hidalgo County alone. These underserved populations are more likely to be uninsured, and as a result, less likely to regularly access preventative healthcare. Indeed, Hispanic women are more likely to present to care for breast cancer in advanced stages3.
Multiple challenges and barriers exist in providing clinical services to this population, both cultural and institutional. With specific regard to cancer prevention, the National Comprehensive Cancer Network recommends genetic risk assessment and counseling for individuals with a family history of breast or colorectal cancer4,5. While over one hundred genetic counselors are employed within the state of Texas, none are providing cancer genetic risk assessment along the border of southern Texas. This healthcare disparity has far-reaching effects, both for the preventative healthcare of the index patient, as well as future preventative efforts for their family members.
Funded by the Cancer Prevention and Research Institute of Texas, Genetic Risk Assessment for Cancer in All South (GRACIAS) Texas provides genetic risk assessment, counseling, genetic testing coordination, as well as preventative screening measures, such as mammography and colonoscopy, to individuals with personal or family histories of breast or colorectal cancer.
This population shares many of the barriers identified in other minority populations, including lack of resources, lack of insurance, distrust of the medical system, and family and employment obligations that preclude access to care. However, at the mid-point of our three-year grant, GRACIAS Texas has identified unique barriers to providing clinical cancer genetics services to this population not otherwise reported in the literature. These include fragmentation of family structure across the US-Mexico boundary, flux of individual medical care between the two countries and variability in citizenship status, which adds to the complexity of cancer genetic risk assessment, counseling, and education regarding risk reduction options. Although the preferred spoken language in much of the border population is Spanish, even the provision of bilingual personnel cannot adequately compensate for the high illiteracy rates, which limits use of education resources.
1) www.census.gov
2) Texas Center for the Advancement of Literacy and Learning, 2009
3) Ramirez A, Thompson I, Vela L. South Texas Health Status Review, Springer Press 2013
4) National Comprehensive Cancer Network, Genetic/Familial High-Risk Assessment: Breast and Ovarian, version 1.2014
5) National Comprehensive Cancer Network, Genetic/Familial High-Risk Assessment: Colorectal, version 2.2014
Supported by CPRIT PP120089(GT)
Citation Format: Lindsey Mette, Ivette Torres, Anna Maria Pulido Saldivar, Natalie Poullard, Gail Tomlinson. Barriers to cancer genetic risk assessment in the border region of south Texas. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A35.