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Fam Cancer. 2012 Sep;11(3):493-502. doi: 10.1007/s10689-012-9541-7.

Outcomes of a systems-level intervention offering breast cancer risk assessments to low-income underserved women.

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Division of Health Outcomes and Health Behaviors, Department of Oncology, Lombardi Comprehensive Cancer, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.


Hereditary breast and ovarian cancer risk assessments (CRAs) are underutilized by low-income and racial/ethnic minority women, potentially exacerbating cancer-related disparities observed within these populations. We deployed and evaluated a systems-level intervention designed to identify patients potentially at-risk for hereditary breast/ovarian cancer, refer them for CRAs, and facilitate CRA utilization at an urban community-based breast health care center. Cancer family history forms were completed by patients seen at the center during an 18-month period and reviewed by staff for CRA eligibility against published referral criteria. A patient navigator educated eligible patients about the benefits of CRA, navigating interested patients to this service. CRA-specific patient interest and utilization outcomes are reported. In total, 94.7 % of all patients (n = 2,436) completed forms and 65 patients (2.7 %) met CRA eligibility criteria. Most eligible patients (72.3 %) were interested in CRA. Interested patients had a greater risk for hereditary breast/ovarian cancer (i.e., more affected relatives, greater objective risk scores) than uninterested patients: 57.4 % scheduled a CRA appointment and 51.9 % of scheduled patients utilized CRAs. Patients scheduling a CRA were contacted in less time and required fewer follow-up contacts by the patient navigator, and were more likely to be African American, than those who declined a CRA or were lost to follow-up (all p's ≤ .05). The systems-level intervention successfully identified patients eligible for CRA and linked interested and at-risk patients with CRA resources. More intensive patient navigation addressing the unique barriers encountered within this population may be required to enhance utilization.

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