A feasibility study of breast cancer genetic risk assessment in a federally qualified health center

Hoskins, Kent; Tejeda, Silvia; Vijayasiri, Ganga; Chukwudozie, Ifeanyi Beverly; Remo, Mylene; Shah, Hiral; Abraham, Ivy; Balay, Lara; Maga, Tara; Searles, Ericka R.; Korah, Veena J.; Biggers, Alana; Stolley, Melinda R.; Warnecke, Richard B.

doi:10.1002/cncr.31635

Cited by 21 publications

(43 citation statements)

References 38 publications

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“…The PAT has the highest sensitivity (100%), high specificity (93%) and is sensitive to BRCA1/2 risk (Hoskins et al, 2006; Hoskins et al, 2018;Teller et al, 2010). The instrument was tested on diverse race/ethnic groups and income levels (Hoskins et al, 2018); however, no study has examined its utility in Hispanic populations. The PAT point-scoring system assigns a certain value for each case of breast cancer within a family, accounting for both maternal and paternal lineages.…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we test the Pedigree Assessment Tool (PAT), because it is one of the tools recommended for risk evaluation (Hoskins et al, 2018; Hoskins, Zwaagstra, & Ranz, 2006; Moyer, 2014) and because of its ease of use in both a community and clinic setting compared with other instruments like the Myriad II and Penn II (Teller et al, 2010). We make use of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST) data to assess the utility of the PAT in detecting the prevalence of HBC in our target population.…”

Section: Introductionmentioning

confidence: 99%

“…Given the uniqueness of the population—uninsured and Hispanics—the BEST data provides an opportunity to evaluate for sociodemographic risk factors among vulnerable populations. In addition, while the PAT has been used in other low-income race/ethnic minority groups (Hoskins et al, 2018), this study assessed the feasibility of its use among Hispanics. The study was approved by the Texas Tech University Health Sciences Center El Paso Institutional Review Board.…”

Section: Introductionmentioning

confidence: 99%

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Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Salinas

Roy

Dwivedi

et al. 2019

Hisp Health Care Int

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Purpose: This article describes the risk of hereditary breast cancer (HBC) in low-income Hispanic women living on the U.S.–Mexico border using the Pedigree Assessment Tool (PAT). Method: The PAT was administered as part of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST). Baseline data ( n = 1,966) from this program was used to analyze risk factors for HBC. Analysis was conducted to determine significant covariates associated with the presence of any PAT risk factors. Results: The PAT identified 17% (95% CI [15%, 19%]) of the women in the study as having some risk of HBC. Having had a mammogram within 3 years was significantly associated with having any PAT risk factors (odds ratio [OR] = 1.79, p = .006). Women who immigrated to the United States during childbearing age (OR = 0.610, p = .009) or during peri/menopause (OR = 0.637, p = .024) were significantly less likely to have any PAT risk factors. Discussion: The PAT instrument detected a substantial pool of women who may be at risk for HBC. A significant proportion of these women were not up to date mammogram. Conclusions: The PAT is an effective tool to identify women at risk for HBC and encourage regular screening.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Salinas

Roy

Dwivedi

et al. 2019

Hisp Health Care Int

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“…This provides an opportunity to impact breast cancer disparities by identifying women with the highest risk so that enhanced screening and preventive measures can be initiated, including referral for GC and germline DNA testing of cancer susceptibility genes. Earlier work from our group showed that it is feasible to implement CGRA in federally qualified health centers (FQHC) in underserved minority communities, but uptake of counseling among high‐risk AA women who are referred for GC is very low 22 . Increasing the use of GC among AA women is a key step in developing a successful personalized medicine strategy for addressing breast cancer disparities that tailors screening and preventive care to individual level of risk.…”

Section: Introductionmentioning

confidence: 99%

Development of a culturally sensitive narrative intervention to promote genetic counseling among African American women at risk for hereditary breast cancer

Henderson

Chukwudozie

Comer-HaGans

et al. 2021

Cancer

Self Cite

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BACKGROUND African American women with hereditary breast cancer risk are less likely to undergo genetic counseling and testing compared with non‐Hispanic White women. Inequities in the use of precision cancer care are likely to exacerbate racial disparities in cancer outcomes. A culturally sensitive multimedia narrative intervention was developed to motivate African American women at risk for hereditary breast cancer to engage in genetic counseling. METHODS Development of the intervention was grounded in the Integrative Model of Behavioral Prediction using a phenomenological, deductive approach and employed multiple qualitative methods for data collection, including 1‐on‐1 interviews and story circles with members of the target audience to identify salient themes and lived experiences. Focus group testing was then conducted with members of the group of focus, primary care providers, and community stakeholders. RESULTS Six themes that mapped to the theoretical model were identified. Lived experiences were abstracted from story circle data to create a narrative storyline. Educational content and motivational messaging derived from the 6 themes were embedded into the script. Focus group testing with stakeholder groups was used to refine the intervention. Testing of the final multimedia narrative with focus groups indicated that the intervention was culturally sensitive and authentic, and the messaging was effective. CONCLUSIONS Multiple qualitative data collection methods and a robust theoretical framework of health behavior were key elements for this study to develop a culturally sensitive, narrative intervention that reflects lived experiences and motivates underserved African American women with hereditary breast cancer risk to engage in genetic counseling. This strategy can be applied to mitigate racial inequities in the use of other genomic approaches for personalizing cancer care.

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“…19 Point-of-care educational support can be provided to patients at clinic visits before or during already-scheduled counseling or testing appointments, limiting barriers in teaching and allowing for assessment of understanding in real time. 20 the USPSTF guidelines have been in place for more than a decade, but PCPs need adequate tools to participate fully in preventive oncology.…”

mentioning

confidence: 99%

USPSTF Recommendations for BRCA1 and BRCA2 Testing in the Context of a Transformative National Cancer Control Plan

2019

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, issue of JAMA, the US Preventive Services Task Force (USPSTF) 1 offers updated recommendations for risk assessment, counseling, and genetic testing for the BRCA1 and BRCA2 genes. As in 2013, the USPSTF recommends risk assessment for women with family histories of breast, ovarian, tubal, or peritoneal cancers using risk stratification tools and offering those with positive results genetic counseling and possible testing (Grade B recommendation). The USPSTF continues to recommend against large-scale population risk assessment (Grade D recommendation). The 2019 recommendations explicitly add ethnicities and ancestries associated with pathogenic BRCA1 or BRCA2 gene variants (eg, Ashkenazi Jewish) as an indicator for risk assessment, dramatically expanding the number of testable patients in the primary care setting from the 2013 recommendations. Importantly, the USPSTF emphasizes that "Genetic counseling…should be done by trained health professionals, including trained primary care providers." With the increase in women eligible for genetic counseling and testing under these recommendations and the explicit directive for primary care practitioners (PCPs) to consider clinical genetics training per the 2019 USPSTF recommendations, the oncology community should welcome the opportunity to better integrate comprehensive cancer risk assessment and genetic testing for BRCA1 and BRCA2 into routine preventive medicine.

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A feasibility study of breast cancer genetic risk assessment in a federally qualified health center

Cited by 21 publications

References 38 publications

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Development of a culturally sensitive narrative intervention to promote genetic counseling among African American women at risk for hereditary breast cancer

USPSTF Recommendations for BRCA1 and BRCA2 Testing in the Context of a Transformative National Cancer Control Plan

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