Targeting breast cancer risk earlier

A new grant will expand genetic counseling and testing for women diagnosed with three subtypes of breast cancer labeled as early onset, triple negative and HER2 negative metastatic breast cancers.The Familial Cancer Risk Assessment Program at Christiana Care Health System’s Helen F. Graham Cancer Center & Research Institute received a $150,000 grant from the Association of Community Cancer Centers (ACCC) in partnership with Pfizer Global Medical Grants.

The grant is part of a national initiative to improve the quality of breast cancer care for women. Projects awarded grants seek to address barriers to counseling and BRCA testing for women in order to extend best practices to much larger patient populations, including underserved minorities. Results could also shed light on how changes in testing practices impact treatment decision-making.

“Delawareans will benefit from this project as we improve our ability to identify more individuals at risk who meet evidence-based criteria for genetic counseling and testing,” said Zohra Ali-Khan Catts, MS, LCGC, director of Genetic Counseling at Christiana Care. “By understanding their germ-line BRCA mutational status, patients can participate in informed decision-making about treatment options now or in the future that ultimately may improve their quality of life and reduce morbidity and mortality from breast cancer.”

According to the National Cancer Institute, Delaware is ranked 12th in the United States for incidence of female breast cancer and has one of the highest incidences of triple negative breast cancer, which is more likely to be diagnosed in African-American and Hispanic women. Continued outreach and education to African-American, Hispanic, Asian and Indian communities will increase awareness about the importance of genetic testing with these populations.

The Familial Risk Assessment staff at the Graham Cancer Center will focus on increasing education to health care providers and increasing identification and referrals for BRCA testing, leveraging existing statewide family cancer risk registry data and the relationships they have established as part of a community cancer center. This includes important partnerships with The Tunnell Cancer Center at Beebe Healthcare and Nanticoke Cancer Center at Nanticoke Memorial Hospital.

Goals are to increase identification of HER2 negative metastatic breast cancer patients from current levels at 29 percent to 85 percent; triple negative breast cancer patients (diagnosed at age 60 or younger) from 80 to 90 percent; and early onset breast cancer patients (age 45 and younger) from 81 to 90 percent over the next two years.

Patients diagnosed with these subtypes of breast cancer carry an increased risk of having a BRCA gene mutation. Knowing an individual’s risks can inform treatment options as well as identify a family’s risks for certain cancers.

In a recent ACCC survey of community oncology practitioners, more than 80 percent of respondents reported that 50 percent or fewer of their patients with early or metastatic breast cancer have ever had germ-line BRCA mutation testing. The survey revealed both patient- and provider-related barriers to BRCA testing, including institutional barriers.

“As one of the first community cancer centers in the country to have a genetics program integrated within our multidisciplinary centers and clinical care, we have proven success with the identification and referral of patients with early onset breast cancer (81 percent) and triple negative breast cancer (80 percent),” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Through ongoing education and partnerships along with robust tumor conference participation where the majority of new cancer cases in Delaware are presented, we are well positioned to leverage this success in targeting patients with metastatic breast cancer.”

To date, the Familial Risk Assessment Program at the Graham Cancer Center reports that 95 percent of its patients who tested positive for a BRCA mutation have made a change to their health care management opting for prophylactic surgery, chemoprevention or increased screening starting at a younger age than the general population.

Additional partners on the project include Christiana Care Community Outreach, Breast Center, Tumor Registry, Breast Cancer Research Program and Breast Cancer Research Community Advisory Board.

The Familial Risk Assessment Program and Registry at the Graham Cancer Center documents cancer risk factors that run in families. It is one of the first statewide programs offering genetic counseling and testing with satellite sites in southern Delaware at The Tunnell Cancer Center and the Nanticoke Cancer Center. Five licensed, board certified genetic counselors provide services to Delawareans close where they receive care.