Abstract P1-11-04: Implementation of cancer risk assessment and genetic testing in underserved patients
Authors: Ian K Komenaka, Lisa M Winton, Jesse N Nodora, Lisa Madlensky, Meredith A Heberer, Richard Schwab, Marcia E Bouton, Jeffrey N Weitzel, Maria Elena Martinez
Journal: Cancer Research (2015)

Abstract PURPOSE: There is great disparity in genetic testing for breast cancer. Hispanic/Latina women with breast cancer are more likely to have adverse clinical features and have a high prevalence of BRCA mutations. We propose that Academic-Community clinic partnerships offer great potential to provide access to genetic cancer risk assessment (GCRA) for underserved communities, including Hispanic/Latina women. The study also evaluated the willingness of these patients to participate in biospecimen collection. METHODS: This study assessed the implementation of a limited GRCA and testing service at a safety net institution from July 1, 2011 to December 31, 2013. In the 10 years prior, only two breast cancer patients had undergone genetic testing and both were insured. The inability to perform GCRA was recognized as a critical area of need. Therefore, a breast surgical oncologist received training with City of Hope National Medical Center. The goal is to provide clinicians the appropriate skills to provide GCRA services in areas where these are not available. Three generation pedigrees and sociodemographic information were collected including health literacy, education, self-reported income, employment status, and insurance status. We conducted a comparison of the patient characteristics along the continuum of GCRA, genetic testing, and mutation carriers, and for the latter group, we describe the BRCA mutation profile. RESULTS: 125 patients were offered GCRA and all accepted, of which 70% of this patient population was Hispanic and 66% did not have health insurance. Of the 125 patients, 84 (67%) were recommended to undergo genetic testing and 81 (96%) agreed. Of the 81 patients who underwent genetic testing, 68 were also asked to participate in the City of Hope Cancer Screening and Prevention registry and all but one (94%) agreed. Significant differences between patients who had genetic testing and those who did not were shown for race/ethnicity, insurance, and family history. A higher percentage of Hispanic patients and patients with no insurance underwent testing. Additional trends in differences between patients who were tested vs. those who were not were observed for education and health literacy but these were not statistically significant. Few differences were observed between women who had genetic testing and mutation carriers; however, the number of carriers was too small to merit statistical testing. Twelve of 81 (15%) patients were found to have deleterious mutations, seven BRCA 1 and five BRCA 2. Of the 12 mutation carriers, one patient had ovarian cancer and therefore had already undergone bilateral salpingo-oophorectomy and two others underwent RRSO. Six are either considering RRSO or getting financial assistance for the operation. The last three are still undergoing breast cancer treatment. CONCLUSION: Results of our experience at a safety net hospital with a largely minority and uninsured population show that limited GCRA and testing can be successfully implemented. The great majority of patients agree to undergo counseling, testing, and participate in biospecimen research registries. Current recommendations for genetic counseling are far from being met across the country and this model could be considered for similar safety net populations. Citation Format: Ian K Komenaka, Lisa M Winton, Jesse N Nodora, Lisa Madlensky, Meredith A Heberer, Richard Schwab, Marcia E Bouton, Jeffrey N Weitzel, Maria Elena Martinez. Implementation of cancer risk assessment and genetic testing in underserved patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-04.