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Advisory Committee on Breast Cancer in Young W omen January 9, 2014

Advisory Committee on Breast Cancer in Young W omen January 9, 2014. Monique Martin, MPH, CHES Health Education and Communication Specialist Georgia Center for Oncology Research and Education (Georgia CORE).

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Advisory Committee on Breast Cancer in Young W omen January 9, 2014

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  1. Advisory Committee on Breast Cancer in Young Women January 9, 2014 Monique Martin, MPH, CHES Health Education and Communication Specialist Georgia Center for Oncology Research and Education (Georgia CORE) Funded through a Cooperative Agreement from the Centers for Disease Control to the Georgia Department of Public Health and administered by Georgia Center for Oncology Research and Education in partnership with Emory University, Georgia State University and Morehouse School of Medicine.

  2. Outline • Cancer Care in Georgia • Consortium’s Background • Accomplishments • Education • Policy • Surveillance • Challenges & Successes

  3. Cancer care in Georgia Source: statecancerprofiles.cancer.gov • 159 Counties • 17 Cancer Genetic Counselors • 18 Health Districts • 1 NCI Hospital • 42 CoC Hospitals • Resources are largely based in Atlanta Metropolitan Area

  4. CONSORTIUM’S STRUCTURE Georgia State University Morehouse School of Medicine A Public Private Partnership

  5. PURPOSE • To promote use of evidence-based guidelines for breast and ovarian cancer genetic risk assessment, counseling and testing, and improve the identification of young women at genetic risk for these cancers.

  6. Education • State & National Organizations’ Posters/ Presentations • National Society of Genetic Counselors (NSGC) • Society of Public Health Education (SOPHE) • American Association of Cancer Research (AACR) • International Society of Nurses in Genetics (ISONG) • Oncology Nursing Society (ONS) • American Society of Breast Surgeons (ASBS) • University of Georgia 2nd Annual State of Public Health Conference • Breast Health Seminar @ GA Dept. of Public Health • GA Health News • Cancer Patient Navigators of Georgia at GASCOAnnual Meeting • Georgia Society of Obstetrics and Gynecology • 12 Breast health programs in GA • Georgia Public Health Association (GPHA)

  7. Education Needs Assessments: Young Breast Cancer Survivors Primary Care Residencies Cancer Genetic Counselors Primary Care Providers 275 licensed Primary Care Providers were surveyed. Found a significant HBOC knowledge deficit among Georgia PCPs, particularly with respect to identification of high-risk individuals.

  8. Education Goal: Communicate the importance of genomics in primary care clinical practice to providers and give information on current cancer genomic standards and guidelines.

  9. Policy • Inclusion of a new objective in GA’s Comprehensive Cancer Control Plan • Objective 2.3A: By 2017, increase the number of high risk Georgians with access to breast, ovarian, and colorectal cancer genetic risk assessment (i.e. genetic counseling and testing) by 20%. • Meetings with: • GA Insurance Commissioner • Medical Directors of Leading Health plans • GDPH Telehealth & Partnership for Telehealth Program Directors • Analysis of GA Health Plans

  10. Policy

  11. Policy • Approval of $46,000 Genetic Testing Fund with proceeds from GA Breast Cancer License Tag • Every $22 Dollars from the purchase or renewal of a GA Breast Cancer License Tag is deposited in the Indigent Care Fund for breast health programs for the underserved • Creates a new stream of funding for the underinsured for genetic testing for hereditary breast and ovarian cancer in Georgia. • Available January 2014

  12. Surveillance • USPSTF’s recommendation cites Breast Cancer Genetics Referral Screening Tool (B-RST*) and www.BreastCancerGeneScreen.org • “Simplest and quickest to administer.” *Developed and validated by Cecelia Bellcross, PhD, MS, CGC, Emory University School of Medicine, Department of Human Genetics, Member of Winship Cancer Institute

  13. Surveillance • Website developed using B-RST Algorithm • 6 Questions • 3 Results: • Negative • Moderate • Positive • Targeted provider and public information

  14. Surveillance & Education National Cancer Institute (NCI) Source: http://www.cancer.gov/cancertopics/pdq/genetics MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013 MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013 DEC 2013 Release of USPSTF’s Recommendation Statement– 12/23/2013 BreastCancerGeneScreen.org – web traffic, ~495 unique visitors/month

  15. Surveillance & Education 1184 Public Users

  16. Location of counties with clinics using B-RST screening* Surveillance • * From Top to Bottom: Gwinnett , Cobb/Douglas, DeKalb, Clayton, Bibb, Chatham

  17. Surveillance use of B-RSt in Ga public health Clinics

  18. Surveillance

  19. Surveillance

  20. Surveillance • Data presented collected from 2012 – 2013 • Clinics have varying: • Implementation dates • Structures • Number of providers

  21. Surveillance Patients screened using the B-RST in 6 public health clinics by Zip Code Source: Map by E. Dauria, 2013

  22. Surveillance

  23. Surveillance

  24. Surveillance • Total number divided by number of patients that agreed to follow-up • Obtained detailed family history and provided resource(s)/counseling/education. • Reported breast concern as reason for coming to public health clinic. • Total number of patients with the test result divided by number of patients tested. • Not enough information about genetic change to know whether or not it results in increased risk of cancer.

  25. Summary • Challenges • Newly Funded State • Uncertainty about future funding opportunities (sustainability!) • Limited access to genetic counselors • Lack of genomics awareness among providers & the public • Policy Limbo • Implementation of ACA • Implications of patent challenge • Successes • Collaboration • Work within public health clinics • USPSTF recommendation statement

  26. GEORGIA DEPARTMENT OF PUBLIC HEALTH Barbara Crane, MN, APRN GEORGIA CORE Nancy M. Paris, MS, FACHE Monique L. Martin, MPH, CHES Alice Kerber, RN, MN, APRN, ACNS-BC, AOCN, APNG EMORY UNIVERSITY Winship Cancer Institute Cecelia Bellcross, PhD, MS, CGC Sheryl G. A. Gabram-Mendola, MD, MBA, FACS Victoria Green, MD, MHSA, MBA, JD L. Brannon Traxler, MD GEORGIA STATE UNIVERSITY Robyn Bussey, MBA, MHA Karen Minyard, PhD Christopher Parker, BSc, MBBS, MPH MOREHOUSE SCHOOL OF MEDICINE Roland Matthews, MD Ijeoma Azonobi, MD Thank YouMonique Martin, MPH, CHES(o) 404-584-5640(f) 404-584-8839mmartin@georgiacore.org

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