Results of a program addressing multi-level barriers to completion of hereditary cancer genetic testing (GT) among underserved and minority individuals in Texas.

Abstract

10593 Background: 5-10% of breast and colorectal cancers are hereditary, but uptake of GT among eligible individuals remains low. Our previous study showed that only 10 % of the 150 underserved and minority women deemed eligible for GT based on our validated Cancer Genetic Risk Assessment (CGRA) completed GT. Based on lessons learned, we implemented a multi-level program including: 1) genetic services education; 2) one-stop CGRA screening, scoring, and GT, 3) financial navigation, 4) telegenetics, and evaluated its impact. Methods: This prospective 12-months two-part program was implemented in Harris County, Texas, in 2023-2024. The primary outcome was GT completion. Both participants and providers received education about hereditary cancers. In the first part of the program, women who presented for mammography screening at clinics in underserved communities filled out the CGRA. In the second part, participants who identified as Black filled out the CGRA during events organized by trusted community organizations. The CGRA was scored and, if warranted, a saliva-based GT kit was offered during the visit or mailed later. Our study coordinator assisted with all financial paperwork. When a pathogenic variant (PV) or variant of uncertain significance (VUS) was found, participants received telegenetic counseling; others were notified of negative results. Socio-demographic characteristics and genetic services participation were analyzed via descriptive statistics and standard tests of association. Program implementation was assessed via in-depth interviews with a purposeful sample of participants and providers, which were audio-recorded, transcribed, double-coded, and analyzed via thematic analysis. Results: In the first part of the program, out of 870 women who presented for mammography screening and were approached, 590 (87%) agreed to be screened via CGRA (median age 52), including 537 (91.0%) who identified as Hispanic, 427 (72.4%) with preferred language Spanish. Median annual salary was 19,200. 99 (16.8%) were eligible for GT and 54 (54.5%) completed it, with 35 (64.8%) negative, 14 (25.9%) VUS, 5 (9.2%) PV in MUTYH , NF1, CHEK2, MSH3. In the second part of the program, out of 4,192 people who attended 20 community events, 390 (9.3%) individuals were screened via the CGRA (median age 54); all identified as Black. Median annual salary was 65,000. 187 (47.9%) were eligible for GT and 97 (51.8%) completed it, with 74.2% (72) testing negative, 22.7% (22) VUS, 3.09% (3) PV in RAD51C, CHEK2, BRCA1. GT completion was not associated with race, ethnicity, or salary (p > 0.05). Based on interviews with 56 participants and 16 providers, main GT facilitators included program convenience, while main barriers included cost and fear of results. Conclusions: Our program was successful in improving GT completion among underserved and minority participants. Clinical trial information: NCT05649072 , NCT05694559 .