This project provides support for the Biennial Symposium Series on Minorities and Cancer. The overall goals of the symposium series are to:
-exchange the latest scientific and treatment information and to share strategies for reducing the disproportionate incidence of cancer morbidity and mortality among minorities and the medically underserved in the United States;
-enhance the competency of health care providers, laypersons and survivors in the areas of primary and secondary cancer prevention, early detection and treatment; and

We propose an innovative video teleconference hosted by the Brown University Center for Primary Care and Prevention and the University of Oxford Department of Primary Healthcare with the goals of: 1. Promoting evidence-based best practice models of cancer prevention though applied genetics by primary care physicians and 2. Advancing the role of the primary care scholar in translational genetics research. Our specific aims are to translate emerging genetic epidemiological and pharmacogenetics research into evidence-based practice models for primary care physicians by: 1.

Prophylactic mastectomy (PM) has been shown to reduce the risk of breast cancer 90% in women at high and moderate risk, but its use is limited by low acceptability. Researchers caution that this is a highly personal decision, but patients and providers have little data about psychosocial outcomes of PM. Project goals are: a. To describe the self-perceived benefits of PM and the physical, emotional, and interpersonal impacts; b. To describe the impact of cancer family history and family communication on decision-making for and outcomes of PM; c.

In order to translate the rapid advances of genetic technologies into the realm of preventive medicine, it is imperative that we explore any perceptions about genetic discrimination that may limit access to genetic cancer risk assessment (GCRA) and consequently to risk appropriate cancer screening and prevention. The state of knowledge and opinions about genetic discrimination and protective legislation among physicians who directly influence access to GCRA is largely unknown.

Genetic screening for cancer susceptibility (e.g. BRCA1/2) has become a standard evidence-based practice in cancer prevention and has proven to reduce breast cancer morbidity and mortality. Yet, most individuals and families in whom genetic susceptibility is suspected do not have a BRCA1/2 mutation. Research employing next generation sequencing has revealed that mutations in other genes, such as PALB2, CHEK2 and ATM are associated with elevated risks of breast cancer.

Using emerging genomic information to create opportunities for targeted or risk-based screening in cancer prevention and control is a critical component of President Obama's Precision Medicine Initiative. But precision genomic screening raises multiple ELSI (ethical, legal, social, and policy) concerns. The proposed embedded ELSI research project presents a unique opportunity to follow and assess the ELSI issues that accompany a pioneering randomized pragmatic clinical trial of a risk-based approach to breast cancer screening.