Enhancing Breast Cancer Genomics Best Practices and Policies in the State of Michigan, 2011-2014

The MDHHS Genomics Program, in collaboration with the CDC Division of Cancer Prevention and Control, enhancing a state public health cancer genomics program that encompasses health plan policy interventions, clinical and public health surveillance, and provider education.

The program strives to accomplish Healthy People 2020 (HP2020) objectives to:
1) Increase the proportion of women with a family history of breast and/or ovarian cancer who receive genetic counseling;
2) Reduce the overall cancer death rate;
3) Reduce the breast cancer death rate; and,
4) Reduce late stage female breast cancer.

The current project aims to create a system that will ensure appropriate translation of cancer genomics through all levels of BRCA clinical services:

1. Documentation of key cancer family history and personal history elements to conduct risk assessment

2. Referrals to genetic counseling services of patients at high risk for deleterious BRCA mutations based on personal and/or family history of cancer
3. Appropriate BRCA testing with prior written informed consent explaining risks, benefits and limitations of BRCA testing and appropriate interpretation of test results
4. Provision of related clinical services/interventions (i.e. chemoprevention, prophylactic mastectomy and oophrectomy) for patients with a known deleterious BRCA mutation.

Methods: 
The core MDHHS team includes a project director, coordinator, cancer genomics educator and an epidemiologist. In addition, we have identified the partners needed to accomplish our four program goals:

• Promote adoption of health plan policies to increase coverage of BRCA clinical services for high risk women
• Increase health care provider knowledge and use of BRCA clinical practices recommended by USPSTF and NCCN
• Expand surveillance of BRCA Clinical Practices
• Utilize data to inform best practices, promote policy change, conduct program evaluation, and disseminate findings. Multiple different activities will address each of these objectives.

This project's target population encompasses the entire state of Michigan and includes patients with or at increased risk for specific cancers, providers, health systems, and health insurance plans.  Evaluation is based on methods recommended by the Guide to Community Preventive Services, and is designed to demonstrate an increase from baseline measures.

Expected Outcomes:
After completion of the Cancer Genomics project, we anticipate the following outcomes related to surveillance, education and policy.

Policy

1. Increased understanding of insurance coverage gaps for BRCA Clinical Services
2. Increased payers' awareness, knowledge and use of BRCA clinical practice guidelines
3. Increased number of health plans that have policies consistent with USPSTF and NCCN recommended practices

Surveillance

1. A comprehensive surveillance system for tracking use of BRCA Clinical Services through board certified genetics providers
2. Understanding of statewide trends regarding family history collection for appropriate BRCA genetic referrals
3. Understanding of statewide incidence, trends and mortality of BRCA-related cancer
4. Increased understanding of the patient/provider practices before and after receiving a BRCA genetic test
5. Increased understanding of Michigan HP2020 BRCA progress

Education

1. Increased provider knowledge about validity, utility, and harms of BRCA counseling and testing
2. Increased appropriate referrals for BRCA counseling
3. Increased appropriate BRCA tests ordered and related clinical services 

Results: 
This genomics translation project is now in its second year of activity, with data analysis currently underway. For additional information on outcomes thus far, please see our Cancer Genomics Epidemiology webpage.

Promoting Cancer Genomics Best Practices through Surveillance, Education and Policy Change in the State of Michigan, 2008-2011

Additional progress will be shared on this website in the future. For further information, please call 1-866-852-1247 or email Genetics@michigan.gov 

Michigan's Cancer Genomics project is supported by Cooperative Agreement #1U58DP003798 from the Centers for Disease Control and Prevention (CDC). The contents of this webpage are the sole responsibility of the authors and do not necessarily represent the official views of CDC.

Last updated: 06/23/2022