Abstract PS4-09-26: Implementation of Integrated Mammography and Genetic Evaluation Services (IMAGES) in Underserved Communities

Abstract Background: Annual screening mammography has played a significant role in breast cancer diagnosis, lowering mortality and morbidity. Uninsured women are 40% less likely to receive guideline-based mammogram screening resulting in more advanced stage breast cancer, requiring more intense treatment or having fewer treatment options. Additionally, 10-15% of all breast cancers are due to an underlying germline mutation, which increases an individual's lifetime risk of developing breast cancer. Identified women with an underlying germline mutation may qualify for increased surveillance or risk reducing surgeries. Despite this, fewer than 15% of women from underserved areas eligible for genetic testing are referred and tested. To bridge this gap, the Integrated Mammography and Genetic Evaluation Services (IMAGES) program was created at MD Anderson Cancer Center (MDACC). IMAGES is a collaboration between Project Valet (PV), a MDACC mobile mammography service, and the MDACC’s Clinical Cancer Genetics (CCG) program to provide access to screening mammograms and hereditary breast cancer risk assessment to uninsured women throughout the surrounding Houston area. IMAGES aims to increase access to screening mammography, identify women at risk for a hereditary breast cancer syndrome, and assist in the navigation and coordination of diagnostic services or cancer treatment. Methods: PV has mobile mammography units established with 8 partnering sites. Uninsured, asymptomatic women ages 40-74 years located in one of the four rural counties southeast of Houston are eligible to participate in IMAGES. Eligible women are referred by a primary care provider or designated medical staff at a collaborating federally qualified health center. At the screening appointment, a community health worker completes patient registration, offers a 1-page genetic cancer risk assessment (GCRA), which collects personal and family history of cancer, and obtains all relevant consent forms. Once the patient completes the mammogram, PV staff will inform the patient and their health care provider of the results and coordinate additional follow-up, as needed. If the patient elected to complete the GCRA, a genetic coordinator scores it to determine if the patient meets NCCN criteria for genetic testing of hereditary breast cancer syndromes (ATM, BARD1, BRCA1, BRCA2, CDH1, CHEK2, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11 and TP53). The genetic coordinator will contact patients eligible for genetic testing to offer and coordinate genetic testing via saliva samples. Negative genetic test results are disclosed to the patient by the genetic coordinator while variant of uncertain significance and positive results are returned by an MDACC genetic counselor. Descriptive demographic and behavioral statistics will be used to analyze data and summarize outcomes of the program between and within community health clinic sites. Results: This project started March 1, 2024, and is currently ongoing. To date, 1529 of women have received screening mammograms and 334 have completed diagnostic follow-up. Of those screened, 886 completed the GCRA, 117 were eligible for genetic testing, and 3 have completed genetic testing. Conclusion: IMAGES is an ongoing service project designed to increase access to screening mammography and genetic evaluation for women in underserved communities in the surrounding Houston area. So far, we have shown it is feasible to integrate the GCRA into mammography screening clinics. Efforts are being made to streamline the genetic testing process. Once the project is completed, further analysis will be done to assess total outcomes. Funding: This project is supported by the Cancer Prevention 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-26.