Integrating HBOC Integrating HBOC Screening into Public Screening into Public Health PracticeHealth PracticeAmber Roche, MPHBreast, Cervical, and Colon Health Program (BCCHP)

Public Health – Seattle & King County

Genomics Objective G-1:Increase the proportion of women with a family history of breast and/or ovarian cancer who receive genetic counseling

Baseline: 23.3% Target: 25.6% (10% improvement)

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=15

Federal (CDC), state, and Komen funding Serves low-income clients without insurance, or

with high deductibles Helps eligible clients get screened for breast,

cervical, and colorectal cancers Connects clients with diagnostic services and

treatment Pays for services Works to improve access/reduce barriers to

care

Breast screening & annual exam

Cervical^ Colon

40-64, or35-39, if being seen for breast

symptoms, or64+ if ineligible for Medicare

 Priority for Mammography:

Ages 50 or older, and last mammogram > 2 yearsSuspicious breast findingsStrong family history or other high risk

  

If last pap normal & > 3 years or co-testing (Pap normal and HPV negative) > 5 years:40-6435-39, if being seen for breast symptoms 

^As per USPSTF 2012 Cervical Cancer Screening

Guidelines. If not eligible for Pap Test, pelvic exam paid

only if done as part of visit for breast screening/annual exam

50-64or

64+ if ineligible for Medicare

orUnder 50 if 1st degree

relative (parent, sibling, child) was diagnosed prior to age 60 with colon cancer or pre-

cancerous polyps

At or below 250% of Federal Poverty Level (FPL)*Uninsured or Underinsured (deductible over $500)

Washington State Residents

*mammography and breast diagnostics available to clients at or below 300% FPL (Komen funding)

BCCHP:Identify clients with family history of HBOC, and refer to genetic counseling

Those diagnosed with breast cancer All enrolled clients

Genetic counselors discuss contacting family members Beyond BCCHP:Providers ID women at risk, & make referrals.

Use EMR capabilities?

DOH revised questions about family history of breast/ovarian cancer on the BCCHP history & exam form

Promoting: Cancer Family History Guide (developed by the

Michigan Department of Community Health) Online Breast Cancer Genetics Referral

Screening Tool (developed by Cecelia Bellcross, PhD, MS, CGC): http://www.brcagenscreen.org/

Data fields on forms vs. in data system Ability to run reports of clients with

family history Limited time, not highest priority

Training clinic staff Possibility for inappropriate referrals Reality of EMRs Who to refer clients to? How to pay for genetic counseling and

testing Will these be Essential Health Benefits?

Pilot project Student labor! Involve patient navigators