Impact of genetic cancer risk assessment on cancer screening and prevention behaviors in an underserved predominantly Latina population.

B39

Genetic cancer risk assessment (GCRA) has the potential to identify persons at increased risk for cancer prior to the onset of disease, when early detection or prevention strategies would be most effective. Despite clinical studies documenting the efficacy of cancer risk reduction measures in high-risk individuals, low-income, underinsured or ethnic minority individuals have a disproportionate burden of cancer and limited access to GCRA. Methods: Cancer Screening & Prevention Program Network outreach clinics were established in two regional indigent healthcare delivery systems, QueensCare Health & Faith Partnership and Olive View Medical Center. Ninety-two of 104 (89%) probands referred for GCRA by their clinician attended their scheduled consultation. All participants were consented and enrolled in an IRB-approved hereditary cancer registry at the time of their consultation. The consultation was conducted by an experienced bilingual cancer risk counselor/physician team and risk management recommendations were given based on BRCA test results or empiric risk estimates. In addition, 27 at-risk relatives (ARR) of BRCA carriers entered study and underwent informative BRCA testing. Baseline health behaviors were obtained by survey pre-GCRA and adherence to cancer screening and prevention recommendations was assessed at least 1-year post-GCRA via a mailed follow-up questionnaire. Items included current status of health, perceived cancer risk and risk management activities. A telephone call was made to prompt survey completion one week following the mailing. Results: Of 119 participants, 94 were eligible for 1-year follow-up and constitute the sample for this analysis; follow-up data was obtained on 72 (77%); 57/74 probands and 15/20 ARR. All respondents were female and the majority were of Latina descent (83%). Forty-three (60%) had breast cancer (11 bilateral), 2 (2.8%) had ovarian cancer and 27 were unaffected. Mean age of breast cancer diagnosis was 37.7 years. Deleterious BRCA mutations were detected in 14/40 (35%) probands, and 9/15 (60%) ARR (from 9 families). As of 1-year post-GCRA, risk-reducing salpingo-oophorectomy was obtained by 7 of 15 (47%) BRCA carriers over age 35, 3 of whom also obtained risk-reducing mastectomy. Across all risk categories, of those with at-risk breast tissue and of appropriate age for screening, post-GCRA 44/62 (71%) were performing monthly self-breast exams, and 57/62 (92%) obtained clinical breast exams and 46/55 (84%) obtained a mammogram as recommended. Overall, compared to baseline more risk appropriate screening and prevention behavior was exhibited post-GCRA. Conclusion: Underserved women embraced the opportunity for GCRA services, attended their scheduled consultations, had a high level of participation in follow-up surveys and showed a positive impact on cancer screening and prevention behaviors.