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    Research Grants Awarded

    Cancer Risk Counseling on Underserved Women

    Study Section:
    Population Specific

    Scientific Abstract:
    Genetic cancer risk assessment (GCRA) has the potential to identify persons at increased risk for cancer prior to the onset of disease, when early detection or prevention strategies would be most effective. Low-income, underinsured, or ethnic minority individuals have a disproportionate burden of cancer and very limited access to GCRA. Lack of Hispanic-specific health research has hindered the development of population-specific prevention and treatment efforts and limited the scope of comparative studies of cultural and genetic factors that influence cancer risk and prevention processes. The primary purpose of this project is to evaluate the effect of GCRA on a population of underserved women of predominately Hispanic descent, and examine a cognitive-social-cultural model of perceived access to care that can guide future interventions with in this population. Culturally competent GCRA should promote changes in breast and ovarian cancer screening and prevention behaviors by increasing both awareness of cancer risk and the likelihood of pursuing available measures. The following aims will be addressed: 1) Assess the cognitive, social and cultural factors influencing perceived access to cancer screening and prevention behaviors, and test the cognitive-social model of perceived access 2) Evaluate changes in breast and ovarian cancer screening and prevention behaviors after culturally relevant GCRA. All participants will undergo GCRA following referral by their primary physicians. Genetic testing for a BRCA mutation will be offered when there is medical necessity and a reasonable calculated probability of a detectable mutation. Cancer screening and prevention recommendations will be given based on genetic test results or empiric risk estimates. Participants will complete survey instruments measuring perceived access, social support, self-efficacy, coping, expected outcomes, acculturation, knowledge of hereditary cancer and baseline medical and family history questionnaires at specific time points prior to and following their consultation. An in person follow-up interview will be conducted one-year post-GCRA in which adherence to risk management recommendations will be assessed. The results of the proposed project will help to fill a void in applied cultural/behavioral genetic cancer risk research in high-risk Hispanics and will be important to maximize cultural competency in the design of future interventional studies within this rapidly growing population.

    Lay Abstract:
    Genetic cancer risk assessment (GCRA) may identify persons at higher risk for cancer before they develop disease, when screening and cancer prevention efforts would be most effective. Low-income, underinsured, or ethnic minority individuals have higher rates of cancer and little access to GCRA. This project’s primary purpose is to evaluate GCRA’s effect on a group of underserved women of predominantly Hispanic origin and examine a theoretical model to help explain their response to GCRA, level of knowledge acquired and effect on behavior. Elements of the model include knowledge, social and cultural factors and their influence on perceptions and actions regarding cancer screening and prevention. Providing these women with GCRA services adapted to enhance learning for a Hispanic audience should increase both awareness of their cancer risk and the chance that they will pursue available cancer screening services. Specific aims include: 1) Assess important knowledge, social and cultural factors and their influence on perception of access to screening and prevention activities, 2) Evaluate changes in breast and ovarian cancer screening and prevention behaviors after a culturally adapted version of GCRA. Participants will be referred by their primary doctors. They will fill out surveys about the availability of health services, the amount of support they receive from family and friends, their ability to perform certain tasks, how they deal with stressful situations, the benefits of cancer screening, the language they speak, read and write, their knowledge of cancer genetics and medical and family history questionnaires at specific time points before and after GCRA. Participants will be offered free BRCA genetic testing if there is a high probability that they have a BRCA mutation and if test results will influence their medical care. All participants will be given appropriate cancer-screening recommendations based on their personal and family history of cancer and their genetic test results if tested. An in-person follow-up interview will be conducted with participants one year post-GCRA. Currently, there is little data on health-related research on Hispanics, particularly in cancer genetics. This research project will help fill the critical void in social, cultural and behavioral research in cancer genetics in Hispanics and will help in the design of future cancer prevention studies in high-risk Hispanic populations.