Implementing a Screening Tool for Identifying Patients at Risk for Hereditary Breast and Ovarian Cancer: A Statewide Initiative

Traxler, Lucy; Martin, Monique; Kerber, Alice S.; Bellcross, Cecelia; Crane, Barbara E.; Green, Victoria; Matthews, Roland; Paris, Nancy M.; Gabram, Sheryl G. A.

doi:10.1245/s10434-014-3921-1

Cited by 29 publications

(20 citation statements)

References 11 publications

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“…As expected, approximately 5% of mammogram patients warranted a genetics referral ( Fig. 1 ) ( Bellcross, CA, et al, 2009 , Dominguez, FJ, et al, 2005 , Brannon Traxler, L, et al, 2014 ). A genetic patient navigator called all underserved patients identified as high-risk and offered them follow-up services.…”

Section: Methodssupporting

confidence: 71%

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

et al. 2015

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BackgroundThe US Preventative Service Task Force recommends that physicians perform a genetic risk assessment to identify women at risk for BRCA1/2 mutations associated with hereditary breast and ovarian cancer (HBOC) syndrome. However, outcomes data after a diagnosis of HBOC syndrome especially in diverse populations, are minimal. Here we asked if genetic screening of high-risk underserved women identified in the mammogram population reduces cancer incidence.MethodsWe evaluated 61,924 underserved women at screening mammography for family histories suggestive of HBOC syndrome over the course of 21 months. Data were collected retrospectively from patients at two safety net hospitals through chart review. A computer model was used to calculate the long-term effect of this screening on cancer incidence by assessing both the mutation detection rate and the completion of prophylactic surgeries in BRCA1/2 mutation carriers.FindingsWe identified 20 of the 85 (23.5%) expected BRCA1/2 mutation carriers in the underserved population. The frequencies of prophylactic mastectomies and oophorectomies in the mutation carriers were 25% and 40%, respectively. Using these data, our model predicted only an 8.8% reduction in both breast and ovarian cancer in the underserved patients. This contrasts with a 57% reduction in breast cancer and 51% reduction in ovarian cancer in an insured reference population. Our data indicate that underserved patients with HBOC syndrome are difficult to identify and when identified are limited in their ability to adhere to NCCN guidelines for cancer prevention.InterpretationScreening for women at risk for HBOC syndrome in mammogram populations will only prevent cancers if we can increase compliance with management guidelines. This study provides prototypic baseline data for step-wise analysis of the efficacy of the use of family history analysis in the mammography setting for detection and management of HBOC syndrome.

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Section: Methodssupporting

confidence: 71%

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

et al. 2015

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“…These will invariably involve some grass-root level efforts with involvement of community outreach programs, counseling initiatives and, possibly, social media. The establishment of partnerships such as Georgia Breast Cancer Genomics Health Consortium to assist young AA women at increased risk of hereditary breast and OC is a step in this direction [ 85 ]. In addition to the various non-biological and biological bases of OC health disparities, there is an added burden of factors that are difficult to classify one way or the another.…”

Section: Discussionmentioning

confidence: 99%

Racial health disparities in ovarian cancer: not just black and white

et al. 2017

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Ovarian cancer (OC) is the most lethal gynecological malignancy, which disproportionately affects African American (AA) women. Lack of awareness and socioeconomic factors are considered important players in OC racial health disparity, while at the same time, some recent studies have brought focus on the genetic basis of disparity as well. Differential polymorphisms, mutations and expressions of genes have been reported in OC patients of diverse racial and ethnic backgrounds. Combined, it appears that neither genetic nor the socioeconomic factors alone might explain the observed racially disparate health outcomes among OC patients. Rather, a more logical explanation would be the one that takes into consideration the combination and/or the interplay of these factors, perhaps even including some environmental ones. Hence, in this article, we attempt to review the available information on OC racial health disparity, and provide an overview of socioeconomic, environmental and genetic factors, as well as the epigenetic changes that can act as a liaison between the three. A better understanding of these underlying causes will help further research on effective cancer management among diverse patient population and ultimately narrow health disparity gaps.

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“…There is a clear need for evidence-based interventions for cancer survivors to increase uptake of genetic counseling services. While web-based cancer risk assessment tools are available [ 14 – 19 ], mobile health intervention directed at increasing use of cancer genetic services has not been widely reported although there are some preliminary data on mobile phone messaging use in the prenatal genetic testing setting [ 20 ]. Given the necessity to increase uptake of cancer genetic counseling in ovarian cancer patients, as well as the potential utility of a mobile application to improve adherence to medical recommendations, we plan to design a mobile intervention to encourage genetic counseling utilization in this population.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of barriers to genetic counseling and potential for mobile technology education among women with ovarian cancer

Niendorf

Lee

Petzel

et al. 2018

Hered Cancer Clin Pract

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BackgroundNational guidelines recommend genetic counseling for all ovarian cancer patients because up to 20% of ovarian cancers are thought to be due to hereditary cancer syndromes and effective cancer screening and prevention options exist for at-risk family members. Despite these recommendations, uptake of genetic counselling and testing is low. The goal of this study was to identify barriers to and motivators for receipt of genetic counseling along with preferences regarding potential use of a mobile application to promote genetic counseling.MethodsThree focus groups were conducted including 14 women with a diagnosis of epithelial ovarian, primary peritoneal or fallopian tube cancer. Topics included understanding of genetic counseling, perceived pros and cons, preferences for receiving health information, and familiarity with mobile phone technology. Transcripts were analyzed using standard procedures of qualitative thematic text analysis and descriptive coding techniques.ResultsSix major themes regarding barriers to and motivators of genetic counseling and use of mobile technology in promoting genetic counseling emerged: (1) need for information, (2) relevance, (3) emotional concerns, (4) family concerns, (5) practical concerns, and (6) mobile application considerations.ConclusionsThese data reiterate previously reported barriers to genetic counseling as observed in other populations. Participants were supportive of the use of mobile technology for promoting uptake of genetic counseling.

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Implementing a Screening Tool for Identifying Patients at Risk for Hereditary Breast and Ovarian Cancer: A Statewide Initiative

Cited by 29 publications

References 11 publications

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

Racial health disparities in ovarian cancer: not just black and white

A qualitative study of barriers to genetic counseling and potential for mobile technology education among women with ovarian cancer

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