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Integrating HBOC Screening into Public Health Practice

Amber Roche, MPH Breast, Cervical, and Colon Health Program (BCCHP) Public Health – Seattle & King County. Integrating HBOC Screening into Public Health Practice. Healthy People 2020. Genomics Objective G-1:

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Integrating HBOC Screening into Public Health Practice

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  1. Amber Roche, MPH Breast, Cervical, and Colon Health Program (BCCHP) Public Health – Seattle & King County Integrating HBOC Screening into Public Health Practice

  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 counseling • Baseline: 23.3% • Target: 25.6% (10% improvement) http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=15

  3. Breast, Cervical, & Colon Health Program in WA • 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

  4. BCCHP in Washington State

  5. BCCHP Eligibility *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 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?

  7. Efforts So Far • 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/

  8. Challenges • Data fields on forms vs. in data system • Ability to run reports of clients with family history • Limited time, not highest priority

  9. Challenges • 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?

  10. Suggestions • Pilot project • Student labor! • Involve patient navigators

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