EHR Intervention to Increase HBOC Genetic Testing

About 5-10% of breast cancers and 10-15% of ovarian cancers are attributed to pathogenic variants (PVs) in cancer predisposition genes, such as BRCA1 and BRCA2. Identifying women with PVs in hereditary breast and ovarian cancer (HBOC) genes can inform risk management strategies, such as enhanced cancer screening, risk-reducing surgeries, and chemoprevention, which have been shown to reduce cancer incidence and mortality. There is significant underutilization of HBOC genetic testing in primary care, with women of color and lower socioeconomic status less likely to receive testing compared to their White or higher income counterparts. Barriers include lack of systematic family history intake, limited access to genetic counseling services, and lack of knowledge among patients and primary care providers (PCPs). The advent of multigene panel testing (MGPT) and rapidly evolving field of cancer genetics have added to the complexity of interpreting genetic test results. To address genetic testing knowledge gaps, the investigators have developed online decision support tools, BNAV (Breast cancer risk NAVigation) for PCPs and RealRisks for patients, which have been rigorously tested among racially/ethnically diverse women in randomized controlled trials (RCTs). To build upon this prior work, the investigators propose the ELISABETH (Electronic health record \[EHR\]-based implementation strategies and decision support for hereditary breast and ovarian cancer genetic testing among multiethnic women) study.