Laboratory-related outcomes from integrating an accessible delivery model for hereditary cancer risk assessment and genetic testing in populations with barriers to access

• Published in: Genetics in medicine Vol. 24; no. 6; pp. 1196 - 1205
• Main Authors: Amendola, Laura M., Shuster, Elizabeth, Leo, Michael C., Dorschner, Michael O., Rolf, Bradley A., Shirts, Brian H., Gilmore, Marian J., Okuyama, Sonia, Zepp, Jamilyn M., Kauffman, Tia L., Mittendorf, Kathleen F., Bellcross, Cecilia, Jenkins, Charisma L., Joseph, Galen, Riddle, Leslie, Syngal, Sapna, Ukaegbu, Chinedu, Goddard, Katrina A.B., Wilfond, Benjamin S., Jarvik, Gail P., Allen, Jake, Anderson, Katherine P., Angelo, Frank, Arnold, Briana L., Bellcross, Cecelia, Bendelow, Tiffany, Biesecker, Barbara B., Breslin, Kristin D., Bulkley, Joanna E., Booker, Kristina F., Caruncho, Mikaella, Davis, James V., Deutsch, Sonia, Devine, Beth, Duenas, Devan M., Eubanks, Donna J., Feigelson, Heather Spencer, Freed, Amanda S., Greaney, Clay, Gruß, Inga, Guerra, Claudia, Guo, Boya, Holup, Joan, Hunter, Jessica Ezzell, Ingphakorn, Chalinya L., Jackson, Paige, Karliner, Leah S., Keast, Erin, Knerr, Sarah, Koomas, Alyssa H., Kraft, Stephanie A., Lee, Mi H., Lee, Robin, Soo-Jin Lee, Sandra, Lewis, Hannah S., Liles, Elizabeth G., Lindberg, Nangel M., Lynch, Frances, McMullen, Carmit K., Medina, Elizabeth, Muessig, Kristin R., Peterson, C. Samuel, Paolucci, Angela R., Perez, Rosse Rodriguez, Porter, Kathryn M., Ransom, Chelese L., Reyes, Ana, Riddle, Leslie S., Robinson, Sperry, Rope, Alan F., Schield, Emily, Schneider, Jennifer L., Shipman, Kelly J., Torgrimson-Ojerio, Britta N., Vandermeer, Meredith L., Varga, Alexandra M., Veenstra, David L., Whitebirch, W. Chris, Lee White, Larissa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2022
• Subjects: Barriers to access; Genomic sequencing; Hereditary cancer risk; Service delivery models; Service delivery models; Hereditary cancer risk; Barriers to access; Genomic sequencing
• ISSN: 1098-3600; 1530-0366
• DOI: 10.1016/j.gim.2022.02.006

This study aimed to evaluate the laboratory-related outcomes of participants who were offered genomic testing based on cancer family history risk assessment tools.
Patients from clinics that serve populations with access barriers, who are screened at risk for a hereditary cancer syndrome based on adapted family history collection tools (the Breast Cancer Genetics Referral Screening Tool and PREMM5), were offered exome-based panel testing for cancer risk and medically actionable secondary findings. We used descriptive statistics, electronic health record review, and inferential statistics to explore participant characteristics and results, consultations and actions related to pathogenic/likely pathogenic variants identified, and variables predicting category of findings, respectively.
Of all the participants, 87% successfully returned a saliva kit. Overall, 5% had a pathogenic/likely pathogenic cancer risk variant and 1% had a secondary finding. Almost all (14/15, 93%) participants completed recommended consultations with nongenetics providers after an average of 17 months. The recommended actions (eg, breast magnetic resonance imaging) were completed by 17 of 25 participants. Participant personal history of cancer and PREMM5 score were each associated with the category of findings (history and colon cancer finding, Fisher’s exact P = .02; history and breast cancer finding, Fisher’s exact P = .01; PREMM5TM score; and colon cancer finding, Fisher’s exact P < .001).
This accessible model of hereditary cancer risk assessment and genetic testing yielded results that were often acted upon by patients and physicians.