Abstract 3465: Dissemination and implementation of genomic cancer risk assessment in Latin America via innovative pairing of clinical training and genomic tools
Authors: Jeffrey N. Weitzel, Cynthia Villarreal-Garza, Kathleen R. Blazer, Josef Herzog, Danielle Castillo, Tanya Chavez, Lenny Gallardo-Alvarado, Talia Wegman, Rosa Alvarez, Karla Unger, Maria Fernandez, Azucena del Toro-Valero, Adrian Daneri Navarro, Abelardo Meneses, Luis Herrera Montalvo, Alejandro Mohar Betancourt, Lily van Tongeren
Journal: Cancer Research (2016)

Abstract Purpose: Access to genomic cancer risk assessment (GCRA) is standard of care in most developed countries, but is not readily available in Latin America. Following needs assessment, a dissemination and implementation intervention, including clinical training and application of inexpensive genomic tools, was used in Mexico to develop a model for vertical integration of GCRA among underserved populations in Latin America. Methods: A roundtable forum with 15 Latin American physicians representing Brazil, Colombia, Mexico, Puerto Rico and Peru was conducted to assess the state of GCRA services and barriers to implementation in these countries. The roundtable was conducted in Spanish, moderated by bilingual cancer genetics clinicians, recorded, transcribed, translated and thematically analyzed. The training resources of the City of Hope Clinical Cancer Genomics Community of Practice (CCGCoP), a flexible, multi-modal program of distance didactics, face-to-face case-based workshops and continuing practice support, were deployed to promote practitioner level GCRA competence among clinicians in Latin America. A common prospective registry protocol was implemented via the Cancer Genetics Community Research Network (CCGCRN), and an inexpensive BRCA screening tool (HISPANEL) was introduced to support GCRA services. HISPANEL sensitivity compared to full sequencing was estimated; quality/content of GCRA process was assessed; and downstream barriers to follow up care were identified. Results: Roundtable findings pointed to the need for a multi-level approach with GCRA training, cost-effective genetic testing, and an evidence-based foundation to support the development of policy, infrastructure and resources to implement and sustain GCRA services in Latin America. Post-training assessments for the 41 Latin American clinicians indicated significant increases in professional self efficacy and skills, and demonstrate the value of CCGCoP training and practice support; 19 alumni (representing 7 sites in Mexico, Peru, Colombia, Brazil and Puerto Rico) joined the CCGCRN. To date 1,010 patients have been accrued to the Latin American component of the CCGCRN cohort. The HISPANEL genomic tool demonstrated a clinical sensitivity of 68-77%, at a cost of $20 per case in Mexico, where site assessments demonstrated successful initiation of GCRA services and facilitated identification of barriers to follow up care. Conclusions: Innovative pairing of multi-modal GCRA training and practice support, combined with access to affordable genomic screening tools, demonstrates the potential for dissemination and implementation of GCRA to improve cancer prevention and control in Latin America. Future directions: address scalability; adapt to other countries; and develop a Spanish-language version of the training program to facilitate broader dissemination. Citation Format: Jeffrey N. Weitzel, Cynthia Villarreal-Garza, Kathleen R. Blazer, Josef Herzog, Danielle Castillo, Tanya Chavez, Lenny Gallardo-Alvarado, Talia Wegman, Rosa Alvarez, Karla Unger, Maria Fernandez, Azucena del Toro-Valero, Adrian Daneri Navarro, Abelardo Meneses, Luis Herrera Montalvo, Alejandro Mohar Betancourt, Lily van Tongeren, Cancer Genomics Community Research Network. Dissemination and implementation of genomic cancer risk assessment in Latin America via innovative pairing of clinical training and genomic tools. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3465.