254611 Identification of Low-Income Women at High Risk for Hereditary Cancer: Final Results from a Randomized Controlled Trial

Monday, October 29, 2012 : 9:30 AM - 9:50 AM

Galen Joseph, PhD , Department of Anthropology, History & Social Medicine, University of California, San Francisco, San Francisco, CA
Susan Stewart, PhD , Division of Biostatistics, University of California-Davis, Davis, CA
Robin Lee, MSGC , Cancer Risk Program, UCSF, San Francisco, CA
Judith Luce, MD , Department of Medicine, Hematology/Oncology, University of California, San Francisco and San Francisco General Hospital, San Francisco, CA
Celia Kaplan, DrPH , Medical Effectiveness Research Center, University of California, San Francisco, San Francisco, CA
Titas Marquez , Director of Cancer Detection Programs: Every Woman Counts, Cancer Prevention Institute of California, Fremont, CA
Sharon Davis, MPA , Associate Director for Community Partnership, Cancer Prevention Institute of California, Fremont, CA
Claudia Guerra, MSW , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
Rena Pasick, DrPH , Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
Our goal was to develop an efficient model to identify uninsured women at high risk for hereditary breast cancer and to encourage them to obtain genetic counseling. To foster translation into practice, we designed strategies for optimal fit within the California statewide toll-free breast/cervical screening phone service, Every Woman Counts (for identification of high-risk women), and the UCSF Risk Program (for delivery of free counseling and testing). At the end of usual service calls to EWC, eligible, consenting callers were screened for family history with a parsimonious “6-point scale”. Those at high risk were called by research staff to complete a baseline survey followed by randomization to: immediate offer of a genetic counseling appointment; or mailed brochure with information on calling for genetic counseling. Two months after the baseline interview, participants were called to complete a follow-up study. The main outcome was receipt of genetic counseling. Over a period of 15 months, 1212 callers were eligible for the study; 709 (58.5%) agreed to participate of whom 102 (14%) were high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% other). Women who received counseling during the two-month intervention included 38.6% of those in the immediate appointment arm vs. 4.5% who received the mailed brochure (p=0.0005). It is feasible to identify low-income women whose family history of breast cancer warrants genetic counseling through a statewide cancer screening phone service. High-risk women are more likely to attend genetic counseling when offered an appointment by phone compared with receipt of a brochure.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
To describe an effective intervention designed to reduce disparities in access to breast cancer genetics services.

Keywords: Genetics, Low-Income

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: With formal training in anthropologic theory and methods, international and national research experience, and expertise in the field of cultural anthropology, I have, in the past six years, come to specialize cancer disparities research. My primary areas of focus are the provision of breast cancer genetics services to medically underserved and culturally diverse women, and recruitment of underserved patients to cancer clinical trials. I received a PHD in Cultural Anthropology in 1999.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.