Public Health clinics: The frontline for expanding reach of family history screening for Hereditary Breast and Ovarian Cancer Restricted; Files Only

Veitinger, Julia (Spring 2022)

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Objectives: To evaluate the impact of increased access to genetic services for underserved and racial/ethnic minority Georgians through a statewide initiative. Additionally, to evaluate any racial uptake differences that exist among the various genetic services.

Methods: Georgia CORE and its collaborators provided training on how to use an online familial history referral tool to all public health clinics in the state. Healthcare providers were responsible for screening their patients during routine care and to refer those identified as high risk for an HBOC mutation to Georgia CORE for further evaluation to determine if genetic testing was warranted. The program was active from 11/1/2012-12/31/2020.

The data collected was analyzed using Chi-Square tests to assess differences between Caucasian and racial minority populations in the uptake of screening, counseling, and testing.

Results: The program reached 79 underserved counties in Georgia. The program screened 29,090 with 26,938 individuals providing their ethnicity and 15,592 (63%) self-identifying as racial minority. The uptake of genetic counseling and testing among minorities was found to be 67.7% (793/1,172) and 52.5% (416/589), respectively. The limited sample size only allowed us to assess differences among Caucasians, African Americans, and Hispanics. African American (63.1% vs. 74.0%, p-value<0.001) and Hispanic (63.1% vs. 72.9%, p-value= 0.028) populations engaged with screening and counseling at statistically significant higher rates than Caucasian populations. However, once the individuals made it to genetic testing, there was no statistically significant difference in uptake between minority and Caucasian populations; only Hispanic populations participated in genetic testing at statistically significantly higher rates than Caucasian populations (69.1% vs. 80.5%, p-value=0.037).

Conclusions: Georgia CORE substantially expanded genetic services in rural settings with large racial minority populations. Racial minorities utilize genetic services when available, sometimes even at higher rates than Caucasian populations. Public health clinics seem like an appropriate setting to provide genetic services to minority populations. The results contradict published literature citing that minority populations do not participate in genetic services. Therefore, access to such services should be expanded in settings such as public health clinics. To expand access genetic services infrastructure needs to be improved. 

Table of Contents

Table of Contents:

1.  Introduction (Pages 1-4)

2. Literature review (Pages 5-16)

3. Manuscript (Pages 17-30)

4. Extended Discussion (Pages 31-44)

5.  Future Directions/Next steps (Pages 45-53)

6.  References (Pages 54-60)

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