Breast cancer is the leading cause of cancer death among Latinas. Latinas also have a high prevalence of BRCA1/2 gene mutations, which increases their risk of developing breast and ovarian cancer. Genetic cancer risk assessments (GCRA) for hereditary breast and ovarian cancer (HBOC) can inform prevention and treatment decisions resulting in breast cancer risk reduction. Despite guidelines to refer women at a high risk of carrying a mutation to GCRA services, Latinas underuse these services. Reasons for Latinas' low GCRA participation include environmental (e.g. access, limited Spanish resources) and psychosocial factors (e.g. knowledge, literacy, emotional concerns). Our preliminary data suggest that improving access may not necessarily translate into uptake and that providers face challenges communicating about genomics with Latina. To develop effective HBOC communication it is key to understand Latinas' intuitive beliefs about GCRA, which are informed by prior experience and culture (mental models), as they impact how risk information is processed. It is also necessary to understand emotional reactions and potential ambivalence about GCRA. There have been few interventions designed to increase GCRA use in Latinas. To move the field forward we will conduct a novel risk communication intervention designed to target mental models, emotions, and ambivalence. Guided by the Theory of Planned Behavior and Social Cognitive Theory, we will conduct a two-phased mixed methods study. In Phase I we will interview key informants (n=10) and at- risk Latinas (n=20) to describe their mental models and other psychosocial factors. These data will inform the risk-benefit messages that will be evaluated and refined in focus groups (n=20) and delivered via Latina actors and a trusted medical personality in a media intervention (i.e.YouTube video). In Phase II we will pilot the intervention on at-risk Latinas (n=40). After the baseline, women will watch the 15-minute video, complete a follow-up assessment, and will be referred to a patient navigator for resource linkages. GCRA uptake will be assessed at 3-months. Our primary outcome is intentions to use GCRA.
Specific aims are:
Aim 1. Describe and portray Latinas' GCRA mental models (risks and benefits perceptions, emotions, etc.) Aim 2. Using data from Aim 1, develop the content of the risk-benefit communication messages for at-risk Latinas and incorporate these into a Spanish-language YouTube video.
Aim 3. Evaluate the acceptability and pre-post intervention differences on the primary outcome (intentions to use GCRA) and intermediate outcomes (e.g. attitudes). We will also explore post-intervention GCRA uptake as a secondary outcome. H.2.1. The intervention will result in a significant increase in intentions to use GCRA H.2.2. The intervention will result in improvements in intermediate outcomes: knowledge, attitudes, self- efficacy, and ambivalence. H.2.3. After the intervention, 30% of Latinas will participate in GCRA by 3 months post-intervention. H.2.4. The majority (?75%) will be satisfied with the intervention

Public Health Relevance

Compared to non-Latina Whites, Latinas have a higher prevalence of BRCA1/2 gene mutations but lower use of genetic cancer risk assessments services (GCRA). This study will develop and assess the impact of a novel culturally targeted media intervention to improve psychosocial outcomes and GCRA use in Latinas at-risk of hereditary breast and ovarian cancer. If the intervention is proven to be effective in a future randomized controlled trial, the intervention can be disseminated to clinics and adapted to other ethnic groups.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1)
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Blake, Kelly D
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Georgetown University
Internal Medicine/Medicine
Schools of Medicine
United States
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Hurtado-de-Mendoza, Alejandra; Jensen, Roxanne E; Jennings, Yvonne et al. (2018) Understanding Breast Cancer Survivors' Beliefs and Concerns About Adjuvant Hormonal Therapy: Promoting Adherence. J Cancer Educ 33:436-439
Hurtado-de-Mendoza, Alejandra; Jackson, Monica C; Anderson, Lyndsay et al. (2017) The Role of Knowledge on Genetic Counseling and Testing in Black Cancer Survivors at Increased Risk of Carrying a BRCA1/2 Mutation. J Genet Couns 26:113-121