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

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


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans
  • Breast Neoplasms / genetics*
  • District of Columbia
  • Family
  • Female
  • Genetic Counseling*
  • Humans
  • Medical History Taking
  • Middle Aged
  • Ovarian Neoplasms / genetics*
  • Risk Assessment / statistics & numerical data
  • Urban Health Services
  • Vulnerable Populations*