Gorin, Sherri Sheinfeld

1546 Background: High risk types of the human papilloma virus (HPV) are necessary though not sufficient causes of the vast majority of cervical cancers. Black women have the highest prevalence of HPV (20.6%, 95% CI, 19.8–21.5%), followed by Latinas (14.1%, 95% CI, 13.9, 14.4%). Black women have the highest rates of mortality from cervical cancer, followed by Latinas. Recent population-based data reveal low uptake of the HPV vaccine (∼25%), particularly among Black women and Latinas. Objectives: The aim of this systematic review is to describe the supports and barriers to HPV vaccine inoculation among Black and Hispanic U.S. women. Methods: We conducted a systematic literature review of studies with more than one observation point or a comparison group that were published over the past 10 years, using a standardized extraction protocol. Inter-rater reliability rates were high (> 0.98). Of 64 English-language articles from peer-reviewed journals, we selected 16 for review. Results: We found barriers at the policy, provider, and patient levels. Barriers at the policy level include access to health care, cost, insurance coverage, vaccine availability, limited knowledge of the HPV vaccine, and media coverage that stigmatizes inoculation. At the provider level, knowledge about HPV incidence and transmission as well as physician recommendation are important factors that influence parental and patient acceptability of the HPV vaccine. Providers report difficulty in discussing STIs with parents, preadolescents, and adolescents. Providers are hesitant to store a vaccine that will be less widely used. Office-based procedures present structural impediments to dissemination of the vaccine. At the patient level, barriers include limited awareness of the vaccine, socioeconomic status, perception of risk based on sexual history, fear of vaccine safety, socio-cultural, economic, and religious factors. Conclusions: Policy, provider, and patient-focused intervention approaches to increasing dissemination of the HPV vaccine are proposed to increase uptake among Black women and Latinas. No significant financial relationships to disclose.

3567 Background: The ability to genotype large numbers of people rapidly and inexpensively for research purposes highlights the need to develop guidelines for providing medically-relevant research results - including unanticipated findings - to study participants. The Colon Cancer Family Registry (C-CFR) is the oldest and largest international colon cancer population-based registry; its experience managing genetic research findings can offer guidance to clinicians and researchers. The C-CFR has enrolled 10,019 cases with colon cancer and 24,708 family members in six registries in the US, Canada, Australia, and New Zealand. Deleterious (“high risk”) germline mutations have been identified in DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, PMS2) and the MutYH gene. The aims of this presentation are to: (1) report the uptake of genetic test results by C-CFR participants; (2) systematically compare disclosure protocols and barriers to uptake by registry; (3) make recommendations to guide clinicians and researchers. Methods: Uptake of genetic test results was calculated from data collected by the C-CFR; key investigators (KIs) from each registry completed a survey about disclosure decision-making; KIs also took part in discussions to generate recommendations. Results: Registry-wide molecular testing has identified deleterious MMR germline mutations for at least one member of 424 families (4%) and 48 biallelic MutYH gene carriers. Uptake of test results ranged from 56-86% (n= 1542) across registries. Barriers to disclosure include: (1) lack of pre-existing notification protocols; (2) logistics of re-consent; (3) limited involvement of genetic counselors at some registries; (4) in the US, the requirement that genetic testing be performed in a CLIA approved laboratory; (5) IRBs declining approval; and (6) budget constraints. Conclusions: Based on our international registry’s findings we recommend that researchers generating genetic information establish plans for disclosure at the outset; obtain subject consent a priori; consider subject knowledge and disclosure preferences; provide guidance and budget for clinical follow-up; and involve genetic counselors.