Enhancing Cancer Genomic Best Practices through Education, Surveillance, and Policy

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This FOA will allow for the development or expansion of state-based programs to promote applications of evidence-based breast and ovarian cancer genomics best practices through education, surveillance, and policy/systems change. Activities will focus on Hereditary Breast and Ovarian Cancer, but may also include Lynch Syndrome. Several system, policy, provider, and individual level barriers make the appropriate identification and treatment of high risk individuals difficult and this FOA will support state efforts to address these barriers and impact breast and ovarian cancer incidence rates. Funded applicants will develop, enhance, and evaluate education, surveillance, and policy activities related to promotion of breast and ovarian cancer genomics. These activities should take advantage of collaborations between funded applicants and partners, both internal (e.g. cancer registry, comprehensive cancer) and external (e.g., academic medical centers, non-profits, clinical genetics sites). Expected outcomes include the improvement of public and provider knowledge of hereditary cancers, genetic counseling, genetic testing, and associated clinical services, the assessment of the burden of hereditary cancers and use of genetic counseling, genetic testing and associated clinical services, and the improvement in access to and coverage of genetic counseling, genetic testing and associated clinical services for high risk individuals. Women with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations have a substantially higher breast and ovarian cancer risk than those without such mutations, with a cumulative risk of developing breast and ovarian cancer up to 57 percent and 40 percent respectively. Women with a personal or family cancer history indicative of a BRCA 1/2 mutation may benefit from genetic counseling and testing. For those who test positive, interventions including chemoprevention, enhanced surveillance or prophylactic mastectomy and oophorectomy can decrease breast cancer incidence and ovarian cancer incidence by up to 95% and 80%, respectively. The United States Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN), have evidence-based recommendations for genetic counseling and testing for hereditary breast and ovarian cancer. People with Lynch syndrome have a higher likelihood of developing colorectal and other (e.g., gastric, endometrial, and ovarian) cancers. The Evaluation of Genomic Applications in Practice and Prevention (EGAPP™) Working Group found sufficient evidence to recommend offering genetic testing for Lynch syndrome to individuals with newly diagnosed colorectal cancer to reduce morbidity and mortality in relatives.

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