1. Integrating HBOC Screening into Public Health Practice
Amber Roche, MPH
Breast, 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 counseling
Baseline: 23.3%
Target: 25.6% (10% improvement)

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 Breast screening & annual exam Cervical^ Colon
40-64, or
35-39, if being seen for breast symptoms, or
64+ if ineligible for Medicare
Priority for Mammography:
Ages 50 or older, and last mammogram > 2 years
Suspicious breast findings
Strong family history or other high risk
If last pap normal & > 3 years or co-testing (Pap normal and HPV negative) > 5 years:
40-64
35-39, 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
50-64 or
Under 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)

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):

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