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

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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.

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Acknowledgments

The City of Hope Clinical Cancer Genetics Community Research Network was supported in part by Award Number RC4A153828 (PI: J.Weitzel) from the National Cancer Institute and the Office of the Director, National Institutes of Health, and the City of hope Intensive Course in Cancer Risk Counseling is supported in part by NCI grant R25-CA171998-01A1 (Weitzel, PI).

This project was supported in part by the iDASH grant awarded by the National Institutes of Health through the NIH Roadmap for Medical Research, Grant U54 HL108460 and by the SDSU/UCSD Comprehensive Cancer Center Partnership (2U54CA132379-06A1).

Dr. Nodora is supported by a Mentored Research Scholar grant from the American Cancer Society (MRSG-11-102-01-CPPB- ACS/MRSG).

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Authors and Affiliations

  1. Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA

    Ian K. Komenaka, Lisa M. Winton & Meredith A. Heberer

  2. Arizona Cancer Center, University of Arizona, Tucson, AZ, USA

    Ian K. Komenaka

  3. University of California, San Diego, Moores Cancer Center, La Jolla, CA, USA

    Jesse N. Nodora, Lisa Madlensky, Richard B. Schwab & Maria Elena Martinez

  4. Division of Clinical Cancer Genetics, City of Hope, Duarte, CA, USA

    Jeffrey N. Weitzel

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  1. Ian K. Komenaka
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  2. Jesse N. Nodora
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  3. Lisa Madlensky
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  4. Lisa M. Winton
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Correspondence to Ian K. Komenaka.

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Komenaka, I.K., Nodora, J.N., Madlensky, L. et al. Participation of low-income women in genetic cancer risk assessment and BRCA 1/2 testing: the experience of a safety-net institution. J Community Genet 7, 177–183 (2016). https://doi.org/10.1007/s12687-015-0257-x

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  • DOI: https://doi.org/10.1007/s12687-015-0257-x

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