Applying a Socio-Ecological Framework to the Uptake of an Online Breast Cancer Genetic Referral Screening Tool in Georgia Open Access

Abstract

BACKGROUND. In 2013, the United States Preventive Services Task Force (USPSTF) published recommendations regarding genetic risk assessment and testing for breast/ovarian cancer susceptibility. Since these guidelines were published, a recognized need has been acknowledged for the development of screening tools to improve identification of those at increased risk for hereditary breast and ovarian cancer. This study aims to answer the following research questions: 1) What is the distribution of the use of an online referral screening tool among Georgia public health districts?? and 2) Are macro-level factors, such as demographic characteristics, income, race and access to healthcare resources associated with screening uptake among eligible women seen in Georgia public health districts?

METHODS. Participants in this study were individuals who used the online referral screening tool embedded in the website (https://www.breastcancergenescreen.org/) between October 2014 and October 2017. This study incorporated several data sets. The online referral screening tool website was used to identify the number of women who passed through screened Georgia public health districts. Census Data and BRFSS Data were also the sources for macro-level variables.

RESULTS. The proportion of women screened in districts was ascertained by collecting available population data from the OASIS tool, a tool by the Georgia Department of Public Health that derives data from the Census. Screening districts were categorized into High, Moderate to Low. Race percentages and mean age were calculated from available data. Two case studies were developed from these data to characterized as high and low screening district and breast cancer incidence, community characteristics, and organizational priorities for screening.

CONCLUSION. The online genetic referral screening tool is helpful for detecting the risk of hereditary breast cancer in the state of Georgia. This tool is widely used throughout districts of public health in the state, and when used correctly, can improve women’s knowledge about their possible risk for hereditary breast cancer. Although there is consistent training and education with staff, there remains a wide disparity in consistent use.  These disparities can be interpreted by considering socio-ecological factors, such as income, race/ethnicity in each district, proportion of providers to patients, and overall incidence/prevalence of breast cancer in that region.

Table of Contents

Table of Contents

Chapter 1: Introduction..................................................................................................................1 

Purpose of Study…………………………………………………………………………………2

 

Chapter 2: Literature Review.........................................................................................................3

National Breast Cancer Causes and Statistics……………………………………………….4

Breast Cancer Statistics in State of Georgia………………………………………………….5

Breast Cancer and Genetic Risk……………………………………………………………….5

Health Disparities in Breast Cancer……………………………………………………………7

Initial Implementation of Breast Cancer Genetic Screening in Georgia………………….11

Implementation of Screening Project…………………………………………………………12

Theoretical Framework………………………………………………………………………...12

 

Chapter 3: Methods.....................................................................................................................15 

Participants……………………………………………………………………………………...15

Measures………………………………………………………………………………………..16

Procedure……………………………………………………………………………………….17

Analysis………………………………………………………………………………………….19

 

Chapter 4: Results.......................................................................................................................20 

Proportion of Women Screened in Districts…………………………………………………20

Race in Public Health Districts………………………………………………………………..21

Mean Age in Public Health Districts………………………………………………………….23

Hereditary Breast Cancer Risk in Public Health Districts….............................................23

Case Study #1…………………………………………………………………………………..26

Case Study #2…………………………………………………………………………………..29

 

 

Chapter 5: Discussion ................................................................................................................31

Recommendations……………………………………………………………………………..33

Limitations……………………………………………………………………………………….33

Conclusion………………………………………………………………………………………34

 

References..................................................................................................................................36

 

Appendix .....................................................................................................................................40

 

 

 

 

 

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	breast cancer BRCA1/2 Socio-Ecological Model
Committee Chair / Thesis Advisor	McBride, Colleen, Emory University
Committee Members	Escoffery, Cam, Emory University Kerber, Alice, Georgia Center for Oncology Research and Education
Partnering Agencies	Georgia state or local agency (not a health department)

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