Improving access to cancer genetic testing for underserved women in southeast Texas

6548

Background: Hereditary breast cancer accounts for 5-10% of all cases, but only 20% of eligible women undergo NCCN guideline-concordant screening. We demonstrated previously that our simple genetic risk screening tool (GRST) and telegenetics improved adherence to genetic testing guidelines and increased high-risk cancer surveillance. Our objective was to identify women eligible for genetic testing using breast cancer screening clinics in underserved communities as entry points, reach them with our tailored program, and measure impact. Methods: This is a prospective study in women presenting for breast cancer screening at The Rose, which provides breast imaging to underserved patients in Houston, TX. Women who consented to participate filled out the GRST and provided socio-demographic information. Those at high risk for hereditary cancer after GRST scoring were provided with educational materials and sent a saliva-based genetic testing kit. When results included a pathogenic variant (PV) or variant of uncertain significance (VUS), individuals received telegenetic counseling and risk reduction resources. Others were notified of negative results by phone. The program included education for providers about importance of genetic testing. Socio-demographic characteristics were analyzed using descriptive statistics. All statistical tests were two-sided. Results: 501 women filled out the GRST. Median age was 52. Median annual salary was $45,000 (IQR 21-75K). 151 (36.3%) were uninsured. 252 (50.3%) identified as White, 230 (45.9%) as Hispanic/Latino, and 106 (21.2%) as Black/African American. 150 (33%) were eligible for genetic testing; 100 could be contacted. Of the 100, 41 declined testing, 40 were lost to follow-up, 19 agreed, and 15 (10% of those eligible) returned the kits. Results included 11 negative, 2 VUS, 1 PV (NF1). Among 41 who declined testing, reported reasons included not wanting to know the results or preference to follow-up with their primary care doctor in 11 (26.8%) each, not enough time or prior genetic testing in 6 (14.6%) each, no reason given by five, and perception that testing was unnecessary in two. Completion of genetic testing was not associated with insurance, salary, family history, or race/ethnicity (p > 0. 05). Conclusions: Our study was successful in identifying underserved women at high risk of hereditary cancer who have not previously undergone genetic testing using a simple screening tool. We reduced barriers to genetic testing by working with a trusted community organization and using remote testing and telegenetics. We did not find any factors associated with genetic testing completion, though results are limited by small sample size. Given the low proportion of patients who completed testing, the next project phase will focus on improving convenience for patients and exploring patient and program-related reasons for non-completion of testing and strategies to overcome these.

Cancer incidence in U.S. adolescent and young adult (AYA) women stratified by race/ethnicity and region

e18529

Background: Cancer incidence is higher in AYA women compared to men and is increasing. National trends by race/ethnicity and region for AYA women in the U.S. are needed to improve health care outcomes. Methods: Data about the top ten cancers 2001-2017, race/ethnicity, and 9 CDC divisions were extracted from US Cancer Statistics Public databases encompassing 99% of US population. Age-adjusted incidence and its annual percent change (APC) were generated using SEER*Stat and trends analyzed via joinpoint regression. All statistical tests were two sided. Results: The top ten cancers in AYA women were: breast (incidence of 26.7 per 100,000), thyroid (16.0), melanoma (11.5), cervical (8.8), colorectal (4.1), uterine (3.5), non-Hodgkin lymphoma (3.6), Hodgkin lymphoma (4.0), and leukemia (3.1). Hispanic women had the highest incidence of uterine and cervical cancer and leukemia. Incidence of breast and colorectal cancer and non-Hodgkin lymphoma was highest in NH Black. Thyroid and colorectal cancer, melanoma, and Hodgkin lymphoma incidences were highest in NH White. Incidence trends included: 1) rise in breast (APC 0.5%), uterine (2.9%) in 2001-2017, and colorectal cancer (2.2% 2001-2013; 6.7% 2013-2017); 2) thyroid cancer (APC 2.1-7.2%) 2001-2015; (-5.7%) 2015-2017; 3) melanoma (-1%) 2005-2017; 4) cervical cancer (-1.4%) 2001-2013; 5) non-Hodgkin lymphoma (-0.5%) in 2007-2017; 5) Hodgkin lymphoma (-0.9%) 2007-2017; 6) leukemia (2.4%) 2001-2012 (p < 0.05). Incidence trends by race/ethnicity included: 1) breast cancer rise in all groups except for NH Black; 2) thyroid cancer rise in all 2001-2015; fall in NH White 2015-2017; 3) melanoma fall in Hispanic and NH Other, rise in NH White 2001-2005); 4) cervical cancer decline in all, Hispanic 2001-2013; 5) colorectal and uterine cancer rise in all; 6) fall in non-Hodgkin lymphoma in NH Black 2005-2017; rise in NH Other; 8) fall in Hodgkin lymphoma in NH White; 7) ovarian cancer rise in Hispanic; 8) leukemia rise in all, NH black 2001-2015 (p < 0.05). Division incidence trends included: 1) breast cancer rise in New England and Middle Atlantic (APC 0.7%); 2) colorectal cancer rise in New England (3.5%) and Mountain (4%); 3) melanoma fall in West South Central (-1.1%); 4) cervix cancer fall in West South Central (-0.3%) and South Atlantic (-0.7%); 5) uterine cancer rise in East North Central (2.3%), South Atlantic (3.0%), and West South Central (4.3%); 6) non-Hodgkin lymphoma rise (0.54%) in Pacific; 7) leukemia rise in South Atlantic (2.4%) and West South Central (0.9%) (p < 0.05). Conclusions: Breast, colorectal, uterine cancer, and leukemia incidence rose in AYA women, while thyroid and cervical (2001-2013) cancer, melanoma and lymphoma incidence fell, with variation by race/ethnicity and division. Research to describe environmental, lifestyle, and healthcare/policy factors and correlate them with outcomes is an urgent unmet need to improve equity in cancer outcomes.

Exploring country priorities and contextual considerations for implementing national cancer control plans (NCCP) among participants of International Cancer Control Partnership (ICCP) ECHO

1581

Background: Promoting NCCP implementation by low- and middle-income countries (LMICs) is key to addressing inequities in cancer outcomes and the global burden of cancer. We explored contextual factors that may influence implementation of NCCP priorities in LMICs. Methods: Seven countries participated in the 2021 International Cancer Control Partnership ECHO (R) geared toward creating a community of practice to inform NCCP implementation. Using qualitative methods, we conducted focus group discussions (FGDs) with country teams who were asked to identify NCCP priorities and provide contextual considerations around implementing these in the 12-months program. FGDs were audio-recorded, transcribed, double-coded, and underwent thematic analysis. Results: Thirty-three participants from 6 Sub-Saharan African countries and 1 country in Asia took part in 7 FGDs, including 14 physicians, 9 non-governmental organizations, 6 Ministry of Health/NCCP and 4 cancer registry representatives. All seven country teams (100%) prioritized cancer early detection, especially for cervical (71%) and breast (57%) cancer, including by educating primary care clinicians (57%) and general population (43%) about cancer signs and symptoms. Related contextual factors included late-stage diagnosis of cancer (43%) and low knowledge about cancer among primary care clinicians and the general population (29% each), respectively. Finding resources for implementation of NCCP priorities was important given lack of funding (57% each). Harmonizing programs and building partnerships for implementation (57%) was prioritized given perceived fragmentation of efforts and benefit of leveraging limited resources (29% each). Improving access to treatment (43%) was a priority given a lack of oncology specialists (29%) and unaffordable treatment (14%). Improving access to palliative care (43%), including by writing guidelines (29%), was prioritized due to late-stage diagnosis and insufficient access to palliative care (14% each). Improving cancer registry data was essential for NCCP program planning (43% each), while cancer research (43%) was key to answering specific questions related to cancer registry data (14%) and program impact (29%). Additional contextual considerations for making progress on these priorities dicussed by country teams included leveraging existing programs (100%) and learning from other countries and ICCP technical experts (57% each). Conclusions: There were similarities in country NCCP priorities and contextual factors affecting implementation. These results allow for future exploration of how LMIC country teams implement NCCPs and examine the value of communities of practice promoted by ICCP and facilitated by ECHO, towards improving cancer outcomes.