Breast cancer (BC) is the most diagnosed cancer in Texas and the second leading cause of cancer death in U.S. women. Hereditary factors, such as pathogenic mutations in the BRCA gene account for 5% to 10% of BC cases and significantly elevate a person’s lifetime BC risk. Screening and early detection can reduce BC risk. Despite national guidelines, mammography and hereditary BC screening rates remain low, particularly among vulnerable populations. Clinical cancer genetic services are especially rare in community hospitals and underserved areas. To address these disparities and improve screening access for underserved populations, we created IMAGES in 2023. IMAGES is an innovative program that integrates two of MD Anderson’s existing screening programs; Project VALET (PV) and Project Genetic Health (PGH). PV is a mobile mammography program providing screening mammography to uninsured, asymptomatic women ages 40+ and coordinates diagnostic follow-up in partnership with Federally Qualified Health Centers (FQHCs). PGH in Clinical Cancer Genetics provides genetic services, including genetic counseling, testing, and risk management for patients with pathogenic germline mutations. Our programmatic footprint, using any of four mobile units, includes underserved clinics across Fort Bend, Matagorda, Wharton and Brazoria counties.   

During mammography screenings, we use a one-page cancer genetic risk assessment (CGRA) that collects personal and family cancer history to identify women at-risk for hereditary BC. These women are then offered genetic testing and counseling as needed. Diagnostic breast imaging services are not provided on mobile units. Instead recognizing patient transportation needs and time constraints, we partner with breast imaging centers and our satellite clinics near patients’ home clinics for diagnostic care. Community Health Workers (CHWs) assist with navigation to diagnostic and treatment resources. Further, using ECHO (Extension for Community Healthcare Outcomes) we provide education and telementoring support to breast cancer screening providers by sharing best practices. To date we have screened 1,216 women with 167 receiving diagnostic follow-up. Due to new clinic set-up, only 45% of those screened were offered CGRA and 90% completed it. Thirteen percent were identified as eligible for genetic testing. All clinical services were provided at no cost to patients. Funded by Cancer Prevention & Research Institute of Texas (CPRIT): PP240012  

Learning Objectives: Discuss challenges in implementing an integrated mobile mammography and genetic risk assessment/screening program Understand the workflow in an integrated genetic risk assessment/screening mammography program Discuss the capacity for implementing a similar program at your institution/organization