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Effective Referral of Low-Income Women at Risk for Hereditary Breast and Ovarian Cancer to Genetic Counseling: A
Rena J Pasick1, Galen Joseph1, Susan Stewart1
1Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont.
Objectives:
To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling.
Methods:
From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months.
Results:
Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those receiving the brochure.
Conclusions:
A public health approach to the rare but serious risk of hereditary breast and ovarian cancer can be successful when integrated into the efforts of existing safety net organizations.
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