Presentation on theme: "Integrating HBOC Screening into Public Health Practice"— Presentation transcript:
1Integrating HBOC Screening into Public Health Practice Amber Roche, MPHBreast, Cervical, and Colon Health Program (BCCHP)Public Health – Seattle & King County
2Healthy People 2020 Genomics Objective G-1: Increase the proportion of women with a family history of breast and/or ovarian cancer who receive genetic counselingBaseline: 23.3%Target: 25.6% (10% improvement)
3Breast, Cervical, & Colon Health Program in WA Federal (CDC), state, and Komen fundingServes low-income clients without insurance, or with high deductiblesHelps eligible clients get screened for breast, cervical, and colorectal cancersConnects clients with diagnostic services and treatmentPays for servicesWorks to improve access/reduce barriers to care
5BCCHP Eligibility Breast screening & annual exam Cervical^ Colon 40-64, or35-39, if being seen for breast symptoms, or64+ if ineligible for MedicarePriority for Mammography:Ages 50 or older, and last mammogram > 2 yearsSuspicious breast findingsStrong family history or other high riskIf 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 exam50-64orUnder 50 if 1st degree relative (parent, sibling, child) was diagnosed prior to age 60 with colon cancer or pre-cancerous polypsAt 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)
6HBOC Screening Options BCCHP:Identify clients with family history of HBOC, and refer to genetic counselingThose diagnosed with breast cancerAll enrolled clientsGenetic counselors discuss contacting family membersBeyond BCCHP:Providers ID women at risk, & make referrals.Use EMR capabilities?
7Efforts So FarDOH revised questions about family history of breast/ovarian cancer on the BCCHP history & exam formPromoting: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):
8Challenges Data fields on forms vs. in data system Ability to run reports of clients with family historyLimited time, not highest priority
9Challenges Training clinic staff Possibility for inappropriate referralsReality of EMRsWho to refer clients to?How to pay for genetic counseling and testingWill these be Essential Health Benefits?