Genetic Variation in Cancer Risk and Outcomes in African Americans

African Americans experience higher cancer incidence and mortality rates, are diagnosed at more advanced stages, and have poorer overall survival than other populations. They are also more likely to be diagnosed with cancers with genetic risk, highlighting the need for robust and accessible interventions to increase recommended

genetic testing (GT). It is also essential to recognize that a legacy of medical mistrust, rooted in historically negative healthcare experiences and medical research abuses, among African Americans may pose culturally specific barriers to uptake of GT. Further, social determinants such low genomic literacy and limited access to

genetic counseling (GC) services may also serve as barriers to the uptake of risk-appropriate GT among African American. This study will build on an established community partnership with the Genomics Research Action Council to adapt a culturally relevant educational intervention to increase uptake of GT among African

Americans. The first goal of the partnership will be to tailor messaging and educational genetic counseling (GC) content to address low genomic literacy and medical mistrust among medically underserved African Americans. The second goal is to increase access to online GC information among African Americans who may be

constrained by socially determined barriers such as access to care, cost, and transportation. Guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model, this study will develop an easily accessible and scalable online educational GC intervention to increase GT among at-risk African Americans. Our aims are:

Aim 1: Guided by the ORBIT model and in partnership with community stakeholders and clinical genetic professionals, adapt (Phase Ia) and refine (Phase Ib) a culturally relevant online educational GC intervention for at-risk African Americans Aim 2: Conduct a Phase IIa single-group proof-of-concept test of the effects of the educational

intervention designed to (a) increase genomic literacy and (b) reduce medical mistrust on uptake of GT among at-risk African American survivors Aim 3: Collaborate with community stakeholders and clinical genetic professionals to translate study findings, develop a roadmap for dissemination to the community, and identify implementation barriers

to prepare for a future Phase IIb randomized trial The impact of this project lies in understanding how to translate novel genetic discoveries into clinical practice for African Americans who may face culturally relevant and socially determined barriers to GT. Developing scalable and sustainable interventions that address these barriers has the potential to significantly reduce a key

driver of racial health disparities in overall cancer burden for African Americans.