Implementation of a multifaceted hereditary breast cancer genetic testing program increased testing completion to 54.8% among eligible underserved women.
Does a multi-level program including education, on-site screening, financial navigation, and telegenetic counseling improve genetic testing completion in underserved women undergoing mammography?
A multi-level intervention addressing education, logistics, and financial barriers achieved a 54.8% genetic testing completion rate among eligible underserved women at safety-net mammography clinics.
Abstract Introduction: Breast cancer (BC) remains the leading cause of cancer-related death among Hispanic women in Texas. While 5-10% of BC cases are linked to hereditary cancer syndromes, the uptake of genetic testing (GT) among eligible individuals remains low, especially in underserved populations. In our prior study using our validated one-page Cancer Genetic Risk Assessment (CGRA) administered at mammography visits, only 10% of 150 eligible underserved women completed GT. To address this gap, we implemented a 12-month, multi-level program in Southeast Texas that included: (1) culturally tailored genetic education, (2) on-site CGRA screening and GT, (3) financial navigation, and (4) telegenetic counseling. Here, we present barriers and facilitators to program implementation. Methods: This 12-month prospective program was conducted in Harris County (2023-2024) within mobile and safety-net clinics of the VALET mammography program. The primary outcome was GT completion. Women undergoing screening completed our validated one-page CGRA. If eligible, saliva-based GT kits were provided onsite or mailed. A bilingual coordinator assisted with consent and financial paperwork. Participants with pathogenic variants (PVs) or variants of uncertain significance (VUS) received telegenetic counseling; others were informed of negative results. From 2022-2023, 870 women were reached; 590 (87%) completed CGRA, 537 (91.0%) identified as Hispanic. Ninety-nine (15.8%) met criteria for GT, and 54.8% completed testing. completed it. 35 (64.8%) tested negative, 14 (25.9%) had a variant of unknown significance, and 5 (9.5%) had a pathogenic mutation in MUTYH, NF1, CHEK2, MSH3 genes. Program implementation was evaluated through semi-structured interviews guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Interviews were transcribed, double-coded, and thematically analyzed. Results: In-depth interviews were conducted with 40 participants (34 patients, 6 staff). Among patients, program participation was motivated by a family history of cancer (73.7%), desire for greater knowledge (28.9%), commitment to one’s health (28.9%) and psychological relief (28.9%). Key facilitators of GT included the ease of testing (71.1%), prior GT knowledge (15.8%), and prior conversation with PCP (13.2%). Barriers included fear and uncertainty after a positive result (68.4%) and financial constraints (34.2%). Patients recommended expanding telehealth (10.5%), reducing costs (7.9%), increasing education (36.8%), and community outreach (21.1%). After participation, patients reported improved screening adherence (68.4%), encouraging family GT (31.6%), and lifestyle changes (18.4%). Notably, 18.4% said their PCP never discussed GT, even with strong family history. Staff were motivated by their desire to improve community health (100%). Facilitators included integration into clinic workflow and provider education (67%). Staff recommended more education (100%), cost reductions (50%), and provider follow-up (33.3%). Barriers included staff shortages (100%) and time constraints (75%). Conclusions: The qualitative data revealed that emotional factors, prior awareness, and ease of access significantly influenced participation. Patient narratives highlighted the importance of culturally responsive education and logistical support in promoting uptake. Staff insights underscored the value of integrating services into existing workflows and the need for sustained provider engagement. These findings offer actionable strategies to improve the design, delivery, and scalability of community-based genetic risk assessment programs. Citation Format: K. Meza, B. Arun, A. Ruiz Cuevas, K. Lee, C. Amaram, S. Shanker, A. Vara, D. Kizub. Barriers and Facilitators to Implementing a Successful Hereditary Breast Cancer Genetic Testing Program for Women Undergoing Mobile Mammography Screening at Safety-Net Clinics in Southeast Texas abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-02-17.
Meza et al. (2026) studied this question. Implementation of a multifaceted hereditary breast cancer genetic testing program increased testing completion to 54.8% among eligible underserved women.