Participation of low-income women in genetic cancer risk assessment and BRCA 1/2 testing: the experience of a safety-net institution

Abstract

Some communities and populations lack access to genetic cancer risk assessment (GCRA) and testing. This is particularly evident in safety-net institutions, which serve a large segment of low-income, uninsured individuals. We describe the experience of a safety-net clinic with limited resources in providing GCRA and BRCA1/2 testing. We compared the proportion and characteristics of high-risk women who were offered and underwent GCRA and genetic testing. We also provide a description of the mutation profile for affected women. All 125 patients who were offered GCRA accepted to undergo GCRA. Of these, 72 % had a breast cancer diagnosis, 70 % were Hispanic, 52.8 % were non-English speakers, and 66 % did not have health insurance. Eighty four (67 %) were offered genetic testing and 81 (96 %) agreed. Hispanic women, those with no medical insurance, and those with a family history of breast cancer were significantly more likely to undergo testing (p > 0.01). Twelve of 81 (15 %) patients were found to have deleterious mutations, seven BRCA1, and five BRCA2. Our experience shows that it is possible to offer GCRA and genetic testing even in the setting of limited resources for these services. This is important given that a large majority of the low-income women in our study agreed to undergo counseling and testing. Our experience could serve as a model for similar low-resource safety-net health settings.

Payer Coverage for Hereditary Cancer Panels: Barriers, Opportunities, and Implications for the Precision Medicine Initiative

“…22,23 This creates payment uncertainty among payers and among patients within one payer, impeding the ability of medical institutions to develop consistent ordering and clinical protocols and exacerbating heterogeneity of related clinical decisions and practices. Further, variability of HCP reimbursement may increase already existing disparities in access to cancer genetic testing, 42–44 particularly for medically and socioeconomically vulnerable patients unable to pay out-of-pocket for the more contemporary multigene tests. Our study’s findings clarify the confusing HCP reimbursement environment and could help medical institutions’ shorter-term efforts to reduce the exposure to reimbursement uncertainty and address the challenges described.…”

The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations

“…Delivering Genomic Medicine in Non-Academic Institutions Under the right circumstances, the uptake of genetic services can be high. This may be especially true for germline cancer susceptibility testing, even when offered in a low resource, safetynet clinic 38 where there is often less genetics expertise among clinicians, and patients are diverse in socioeconomic status, ancestry, language, and education. Although knowledge of genetic testing is increasing in diverse communities, 39 social and cultural context can be expected to influence the success of genetic services.…”

Genomic Disparities in Breast Cancer among Latinas

“…118 Another study of women (69.6% were Latinas) seen in the safety-net hospital setting reported that 96.4% of them underwent BRCA testing when it was recommended to them. 119 Once Latinas were referred, Olaya et al 120 found that they are equally likely as the general population to complete BRCA testing. Overall, 52% completed genetic testing, and no differences by race and ethnicity were observed.…”