# Evaluating an evidence-based family history screening program adapted to increase reach and uptake of screening for BRCA-associated cancers in rural public health clinics

> **NIH NIH R37** · EMORY UNIVERSITY · 2023 · $615,683

## Abstract

PROJECT SUMMARY
Brief and low-cost family history-based screening assessments to identify families at high risk for BRCA-
associated cancers have been endorsed by national guidelines (e.g., USPSTF) and public health organizations
(e.g., CDC). Public health departments offer an infrastructure for systematically reaching women historically left
out of cancer genomic advances (e.g., uninsured, Black women, rural residents). Georgia is among the few states
to have implemented statewide family history screening for BRCA-associated cancers. Despite its potential,
current clinic-based approaches that identify at risk women are not sustainable and show limited reach.
Additionally, uptake of follow-up cancer screening is suboptimal and solely focuses on women screened as high
genetic risk. Therefore, we propose a two-phase study to adapt Georgia’s existing statewide family history
screening program and evaluate its effectiveness to increase the number and diversity of women who receive
family history assessment and the opportunity to access risk-stratified follow-up services. Guided by the
Exploration, Preparation, Implementation and Sustainment (EPIS) framework, the aims of this two-phase study
are: Phase I (Exploration & Preparation stages), Aim 1: Conduct a multilevel adaptation of GA CORE’s existing
statewide family history screening program for BRCA-associated cancers to maximize sustainable program reach
and improve communication suitability and effectiveness. Phase II (Implementation stage), Aim 2: Use a multi-
site, parallel group, cluster randomized controlled trial to evaluate effectiveness of the adapted program relative
to the current screening program in promoting uptake of family history screening and correct screening result
interpretation among women ages 25 and older who are receiving care in up to 6 of 14 Public Health Clinics in
Southwest Georgia. Secondary outcomes include the uptake of appropriate risk-stratified screening (e.g., high
risk: genetic consultation and testing; low risk: appropriate breast imaging screening). Aim 3: Use the RE-AIM
(Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct an implementation
research evaluation to measure program process indicators (e.g., reach, fidelity, barriers/facilitators) that may
influence program implementation and sustainability. Our application will be among the first to evaluate a
sustainable multi-level population-based approach to implement evidence-based cancer genetic screening and
to increase the likelihood for fair distribution of genomic advances among diverse populations in rural areas.

## Key facts

- **NIH application ID:** 10731993
- **Project number:** 1R37CA276317-01A1
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Yue Guan
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $615,683
- **Award type:** 1
- **Project period:** 2023-07-06 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731993

## Citation

> US National Institutes of Health, RePORTER application 10731993, Evaluating an evidence-based family history screening program adapted to increase reach and uptake of screening for BRCA-associated cancers in rural public health clinics (1R37CA276317-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10731993. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*