Implementing a family history screening tool to identify individuals with cancer susceptibility in a primary care setting: The Colorado Generations service project

Introduction: Cancer remains a significant public health burden. Individuals with genetic susceptibility have significant lifetime cancer risk but if identified, can be given recommendations for medical management to decrease their risk. Lacking are systematic methods for collecting adequate family histories to identify high-risk individuals. This project sought to increase awareness about hereditary cancer and to facilitate identification of at-risk individuals through a family history screening tool. Methods: A family history screening tool was implemented within primary care and oncology clinics in the Denver area to identify patients at-risk for hereditary cancer. Educational sessions for providers were conducted in tandem. Patients identified as high-risk were navigated to receive follow-up, genetic counseling and testing as appropriate. Results: Educational sessions were conducted at 18 clinics for 115 providers. Over 10,000 individuals were screened; 1,600 (16%) were identified as high risk and mailed education about hereditary cancer along with a family history questionnaire for further evaluation. Of those subsequently referred (150), 81 received counseling and 48 had genetic testing. Individuals counseled were provided screening recommendations and strategies for risk reduction. Services for uninsured patients were covered by the project. Conclusions: This project demonstrated that a screening tool can effectively identify patients at-risk for hereditary cancer in a primary care setting. The major challenge was getting patients to follow-through on referral for counseling. Future efforts to increase awareness and utilization of genetic services may focus on educating providers and addressing barriers for seeking services for at-risk patients.