Presentation on theme: "Integrating HBOC Screening into Public Health Practice"— Presentation transcript:
1 Integrating HBOC Screening into Public Health Practice Amber Roche, MPHBreast, Cervical, and Colon Health Program (BCCHP)Public Health – Seattle & King County
2 Healthy 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)
3 Breast, 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
5 BCCHP 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)
6 HBOC 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?
7 Efforts 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):
8 Challenges Data fields on forms vs. in data system Ability to run reports of clients with family historyLimited time, not highest priority
9 Challenges 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?