Advisory Committee on Breast Cancer in Young Women

January 9, 2014

M o n i q u e M a r t i n , M P H , C H E SH e a l t h E d u c a t i o n a n d C o m m u n i c a t i o n S p e c i a l i s t

G e o r g i a C e n t e r f o r O n c o l o g y R e s e a r c h a n d E d u c a t i o n ( G e o r g i a C O R E )

OUTLINE

Cancer Care in Georgia

Consortium’s Background

Accomplishments

• Education

• Policy

• Surveillance

Challenges & Successes

CANCER CARE in GEORGIA

159 Counties 17 Cancer Genetic Counselors 18 Health Districts 1 NCI Hospital 42 CoC Hospitals Resources are largely based in Atlanta

Metropolitan Area

Source: statecancerprofiles.cancer.gov

Georgia State University

Morehouse School of Medicine

A Public Private Partnership

CONSORTIUM’S STRUCTURE

PURPOSETo promote use of evidence-based guidelines for breast and

ovarian cancer genetic risk assessment, counseling and testing, and improve the identification of young women at genetic risk

for these cancers.

EducationState & National Organizations’ Posters/ Presentations

National Society of Genetic Counselors (NSGC) Society of Public Health Education (SOPHE) American Association of Cancer Research (AACR) International Society of Nurses in Genetics (ISONG) Oncology Nursing Society (ONS) American Society of Breast Surgeons (ASBS)

University of Georgia 2nd Annual State of Public Health Conference

Breast Health Seminar @ GA Dept. of Public Health GA Health News Cancer Patient Navigators of Georgia at GASCO Annual

Meeting Georgia Society of Obstetrics and Gynecology 12 Breast health programs in GA Georgia Public Health Association (GPHA)

275 licensed Primary Care Providers were surveyed.

Found a significant HBOC knowledge deficit among Georgia PCPs, particularly with respect to identification of high-risk individuals.

Paternal Inheritance Autosomal Dominant Inheritance

Highest Risk - Family History Only

Highest Risk - Personal History

0

10

20

30

40

50

60

70

80

90

100

68

56.5

39.8

4.2

47.6

32.836.9

3.6

Recognition of Key HBOC Genetics Concepts among Primary Care Providers by Confidence Level

Very High/High Confidence Level

Average/ Low/ Very Low Con-fidence LevelP

erc

ent

Corr

ect

Source: Schmitt, E., Webster, R., Bellcross, C., & Meaney-Delman, D. (2013). Georgia healthcare provider knowledge, practice patterns, and education needs regarding hereditary breast and ovarian cancer. National Society of Genetic Counselors 2013 Annual Conference.Source: MDCH Provider Survey

Education

Needs Assessments:Young Breast Cancer Survivors

Primary Care Residencies

Cancer Genetic Counselors

Primary Care Providers

Goal: Communicate the importance of genomics in primary care clinical practice to providers and give information on current

cancer genomic standards and guidelines.

Education

Inclusion of a new objective in GA’s Comprehensive Cancer Control Plan Objective 2.3A: By 2017, increase the number of high risk Georgians with

access to breast, ovarian, and colorectal cancer genetic risk assessment (i.e. genetic counseling and testing) by 20%.

Meetings with: GA Insurance Commissioner Medical Directors of Leading Health plans GDPH Telehealth & Partnership for Telehealth Program Directors

Analysis of GA Health Plans

Policy

Policy

Policy

Approval of $46,000 Genetic Testing Fund with proceeds from GA Breast Cancer License Tag

Every $22 Dollars from the purchase or renewal of a GA Breast Cancer License Tag is deposited in the Indigent Care Fund for breast health programs for the underserved

Creates a new stream of funding for the underinsured for genetic testing for hereditary breast and ovarian cancer in Georgia.

Available January 2014

USPSTF’s recommendation cites Breast Cancer Genetics Referral Screening Tool (B-RST*) and www.BreastCancerGeneScreen.org

“Simplest and quickest to administer.”

*Developed and validated by Cecelia Bellcross, PhD, MS, CGC, Emory University School of Medicine, Department of Human Genetics, Member of Winship Cancer Institute

SURVEILLANCE

SURVEILLANCE

Website developed using B-RST Algorithm

6 Questions

3 Results: Negative Moderate Positive

Targeted provider and public information

National Cancer Institute (NCI)Source: http://www.cancer.gov/cancertopics/pdq/genetics

0

50

100

150

200

250

BreastCancerGeneScreen.org – web traffic, ~495 unique visitors/month

MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013

SURVEILLANCE & EDUCATION

0

100

200

300

400

500

MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013

DEC 2013 Release of USPSTF’s Recommendation Statement– 12/23/2013

Moderate18%

Negative73%

Positive9%

Screening Results of Public Users

1184 Public Users

Under 180%

18-4981%

50+12%

Not Specified7%

Age of Public Users

Native Hawaiian / Pacific Islander

0%

Other1%Hispanic /

Latino20%

Caucasian / White29%

African Amer-ican / Black

41%

Asian2%

Not Specified7%

Race/Ethnicity of Public Users

SURVEILLANCE & EDUCATION

SURVEILLANCE

 

 

  

 

 

Location of counties with clinics using B-RST screening*

* From Top to Bottom: Gwinnett , Cobb/Douglas, DeKalb, Clayton, Bibb, Chatham

USE of B-RST in GA PUBLIC HEALTH CLINICS

Clients visit clinic. Clinic staff incorporate HBOC screening into typical process for collecting client’s medical history using BreastCancerGeneScreen.org.

Clients with Moderate & Negative screening results given information. Routine health screenings are encouraged.

Clients with Positive screening results are contacted by a genetics professional, unless they opt-out.

SURVEILLANCE

SURVEILLANCE

SURVEILLANCE

Cobb/Douglas DeKalb Gwinnett Bibb Chatham Clayton

19

41

3217 16 3

108

1134

373263 228 14

B-RST Screening in Public Health clinics (N=2120)# Positive Total # Screened

SURVEILLANCE

Data presented collected from 2012 – 2013 Clinics have varying:

Implementation dates Structures Number of providers

SURVEILLANCE

Patients screened using the B-RST in 6 public health clinics by Zip Code

Source: Map by E. Dauria, 2013

73.2%

(1551)

0.2% (4)

1.2% (26)

12.9%

(273)

8.0% (170)

0.1% (3) 2.7% (57) 1.7% (36)

Race/Ethnicity of Individuals Screened in 6 Public Health Clinics (N=2120)

African American/Black

American Indian/Alaskan Native

Asian

Caucasian/White

Hispanic / Latino

Native Hawaiian/Pacific Islander

Not specified

Other

4.1% (86)

88.3% (1871)

5.1% (109)

2.5% (54)

Age of Individuals Screened in 6 Public Health Clinics (N=2120)

Under 18

18-49

50+

Not Specified

SURVEILLANCE

B-RST Positive Screenings in Public Health Clinics (N=2120)

Positive rt:

Positive Screens in Public Health clinicsNegative/Moderate Screens in Public Health clinics

SURVEILLANCE

1. Total number divided by number of patients that agreed to follow-up2. Obtained detailed family history and provided resource(s)/counseling/education.3. Reported breast concern as reason for coming to public health clinic.4. Total number of patients with the test result divided by number of patients tested.5. Not enough information about genetic change to know whether or not it results in increased risk of

cancer.

95 (74.2%) Pa-

tients

Agreed to

Fol-low Up

128 Positive Patients Screened Patient Follow-Up N (%)1

Successfully Contacted2 66 (69.4%)

Meet NCCN High Risk guidelines 44 (46.3%)

Tested 14 (14.7%)

Patients that reported findings3 20 (21.1%)

N (%)4

Test Results

BRCA 1/2 Positive

Genetic Variant of Uncertain Significance5

Negative

 

1 (7.1%)

1(7.1%)

9 (64.3%)

Pending Test Results 3 (21.4%)

SURVEILLANCE

Challenges Newly Funded State Uncertainty about future funding opportunities (sustainability!) Limited access to genetic counselors Lack of genomics awareness among providers & the public Policy Limbo

Implementation of ACA Implications of patent challenge

Successes Collaboration Work within public health clinics USPSTF recommendation statement

SUMMARY

GEORGIA DEPARTMENT OF PUBLIC HEALTH

Barbara Crane, MN, APRN

GEORGIA CORE

Nancy M. Paris, MS, FACHE Monique L. Martin, MPH, CHESAlice Kerber, RN, MN, APRN, ACNS-BC, AOCN, APNG 

EMORY UNIVERSITYWinship Cancer Institute

Cecelia Bellcross, PhD, MS, CGCSheryl G. A. Gabram-Mendola, MD, MBA, FACSVictoria Green, MD, MHSA, MBA, JDL. Brannon Traxler, MD 

GEORGIA STATE UNIVERSITYRobyn Bussey, MBA, MHAKaren Minyard, PhDChristopher Parker, BSc, MBBS, MPH 

MOREHOUSE SCHOOL OF MEDICINERoland Matthews, MDIjeoma Azonobi, MD  

 

 

THANK YOUMONIQUE MARTIN, MPH, CHES(O) 404-584-5640(F) 404-584-8839MMARTIN@GEORGIACORE.ORG