Study finds education and navigation increase cancer genetic counseling and/or testing

Genetic counseling and genetic testing for mutations in certain genes such as BRCA1 and BRCA2 genes—can help people understand their risk of certain types of cancer that can run in families, and improve outcomes through prevention, early detection, and targeted treatments.

National guidelines recommend cancer genetic risk assessment (CGRA) for all women with epithelial ovarian, fallopian tube, primary peritoneal, and high-risk breast cancer; however, many patients who meet national criteria have not had genetic counseling and/or testing, with the lowest rates among minority, rural, and other underserved populations. Thus, they and their family members are unaware of their hereditary cancer risk.

Researchers at Rutgers Cancer Institute of New Jersey explored informing patients of their potentially increased risk for generically inherited cancers and navigating them to receive a CGRA (genetic counseling and/or testing) through phone-based decision coaching and navigation. The project, called the Genetic Risk Assessment for Cancer Education and Empowerment (GRACE):

• Leveraged statewide cancer registries as a low-cost approach to deliver a remote, telehealth intervention for ethnically and geographically diverse high-risk cancer survivors
• Included a diverse sample of participants from underserved populations, utilizing the New Jersey State Cancer Registry, which, under the direction of Rutgers Cancer Institute and the NJ Department of Health, is a local and national resource for population-based studies into the causes, treatments and outcomes in patients with cancer and for informing them about and recruiting them to intervention trials.

Findings

The findings are published in the Journal of Clinical Oncology. Investigators found that the expanded use of a personalized remote risk communication intervention increased CGRA uptake among women at increased risk of hereditary breast and ovarian cancer.

"The results from our study support the expanded use of personalized remote risk communication and navigation interventions such as our GRACE Project's intervention, to increase genetic counseling and testing," said the study's lead author Anita Kinney, Ph.D., director of the Cancer Health Equity Center of Excellence at Rutgers Cancer Institute and Rutgers School of Public Health, associate director for Population Science and Community Outreach at Rutgers Cancer Institute and professor of biostatistics and epidemiology at Rutgers School of Public Health.

"Our novel approach to patient education and empowerment combined with navigation creates a promising approach to enhance motivation and remove barriers to potentially lifesaving cancer genetic services, including in historically underserved populations."

"Statewide, population-based cancer registries serve as a key resource for this type of research—often the basis for recruiting a large-enough study sample that is both geographically and ethnically diverse," said study author Antoinette Stroup, Ph.D., research member at Rutgers Cancer Institute of New Jersey and Assistant Director of Research and Catchment Data at the Cancer Health Equity Center of Excellence, and director of the New Jersey State Cancer Registry (NJSCR).

"Breast cancer is still the leading cancer diagnosed among women in the U.S. This study undoubtedly provides much needed data-driven, evidenced-based strategies to aid future patient outreach in the area of genetic counseling and testing, which could lead to significant progress in addressing this cancer burden."