Hereditary Breast and Ovarian Cancer

Helping Families Communicate About Hereditary Breast and Ovarian Cancer:
Family Medicine Residency Training Program Learning Collaborative





Early detection, in conjunction with risk reduction, is essential to reducing cancer mortality rates. With an estimated ten percent of cancer diagnoses linked to a high-risk genetic mutation (≅ 200,000/year in the United States), identifying and counseling those individuals who carry the mutation can save lives. However, millions of Americans are unaware that they have a genetic mutation that increases their risk of developing cancer.

Family physicians are at the heart of the early detection and prevention of cancer. This is particularly true with hereditary cancers. Family physicians and their care teams are uniquely positioned to assess their patients' risk and counsel them through options to evaluate and reduce their risk.

This is why the Family Medicine Education Consortium (FMEC) created the 2023 Hereditary Breast Cancer/Narrative Medicine Learning Collaborative. According to the CDC’s Division of Cancer Prevention and Control, only about 41% of primary care physicians refer women with a high risk for breast cancer for genetic counseling and testing. Our challenge is changing this and asking how we can develop the means to stimulate authentic conversations that lead to action.  

Collaborative Background

The FMEC is committed to engaging residency programs in learning collaboratives to advance quality healthcare and medical education. Not only can collaboratives improve care and teaching, but they meet the Accreditation Council for Graduate Medical Education (ACGME) cross-institutional collaboration requirements, which went into effect July 1, 2023. The guidelines state, “Programs are strongly encouraged to partner with other family medicine residency programs through regional learning collaboratives to share resources to facilitate programs and their family medicine practice’s attaining educational and community aims.” To help residencies meet this commitment, the FMEC launched the cross-institutional learning collaborative on Hereditary Cancers in Women and Narrative Medicine in early 2023.

In partnership with the National Association of Chronic Disease Directors (NACDD) and utilizing funding and tools from the CDC’s Bring Your Brave campaign, participating family medicine residency programs convened virtually to learn about women’s hereditary cancer risk, using videos and stories in training and in clinic, and supporting women to learn about their risk, get testing, and find community supports.   

About Bring Your Brave Campaign

Breast cancer is the most common cancer in women in the United States. While breast cancer mostly occurs among older women, in rare cases breast cancer does affect women under the age of 45. Nine percent of all cases of breast cancer in the U.S. are reported in this age group. Risk for breast cancer among young women varies based on factors such as family and personal history of cancer. Many young women do not know their risk for this disease or are not aware of ways to lower their risk.

Understanding cancer risk factors and being proactive may help women lower their risk for getting breast or ovarian cancer at a young age, or lead to detection at an early stage when treatment works best.

The Bring Your Brave Campaignprovides information about breast cancer to women younger than age 45 by sharing real stories about young women whose lives have been affected by breast cancer. For more information, visit the Bring Your Brave Campaign’s resources for healthcare provider education, and to view the manypatient stories, which can be shared with providers and patients via videos, podcasts, and handouts.    

Key Takeaways from the Collaborative

Takeaways at a Glance

  • The Bring Your Brave Campaign is a multilevel training and education tool that can be used to empower patients and healthcare providers.
  • Training in genetic testing, insurance coverage, and other topics will increase the likelihood of successful deployment of the Bring Your Brave Campaign materials from family medicine practitioners to patients.
  • Translations, tools for quick access, and other development of the materials will assist family medicine practitioners in distributing campaign materials to patients,.
  • In the final survey, 70% of programs responded that they had identified gaps in their curriculum that they planned to address utilizing the Bring Your Brave material.
  • The project proved that review and discussion of the resource materials and exploration of the subject increases the likelihood that physicians will conduct regular hereditary cancer discussions with patients.
  • On the final project survey
    • 100% of Resident and 90% of Faculty respondents indicated that they had, or planned to, share the Bring Your Brave resources with patients. During the Collaborative, participants already reached approximately 101 patients using Bring Your Brave Campaign materials or strategies. 
    • Participants have indicated that they have or planned to share the information with colleagues, community support organizations, and other groups outside their programs. When asked the number of individuals they anticipated sharing the information with, Residency Programs reported an average of 60 individuals, resulting in an immediate potential to reach over 550 individuals with Bring Your Brave information.
    • 100% of Faculty members responded that they would continue to distribute the information to new residents in the future, suggesting that information on hereditary cancer and Bring Your Brave will become institutionalized in these programs’ curricula.
    • When asked if participating in the Hereditary Breast Cancer/Narrative Medicine Learning Collaborative increased their likelihood of having hereditary cancer conversations with patients, the majority of participants responded yes. Only one participant selected No, indicating they were already having regular hereditary cancer conversations with patients before the Collaborative.


The Bring Your Brave Campaign is a versatile tool with several possible applications. The FMEC 2023 Learning Collaborative on Hereditary Breast Cancer & Narrative Medicine focused on the Campaign's impact on the training and skill development of family medicine doctors by incorporating campaign materials in residency training programs.

While this project was not designed to evaluate patient outcomes, the ultimate goal of this work is, in essence, to lower cancer mortality rates and save lives. Research has shown that cancer early detection and risk reduction efforts are key, and increasing the identification of individuals who have genetic mutations that increase their risk of developing cancer in their lifetime can significantly impact these outcomes. Since it is estimated that only 41.1% of primary care physicians refer high-risk women to genetic counseling, increasing the likelihood of referral and testing is one step in achieving a lower cancer mortality rate.

To increase the likelihood of family medicine practitioners routinely incorporating hereditary cancer discussions with their patients, we discovered there first must be a demystification of the genetic testing and counseling process. To begin this process, family medicine residency programs can incorporate the review and discussion of the Bring Your Brave resources with residents. This can be achieved in one-off seminars or fully incorporating a Family Medicine Genomics coursework option within training.

In addition, residency programs would benefit from utilizing the Bring Your Brave Campaign as a case study of narrative medicine principles. This serves as an opportunity to educate residents on narrative medicine techniques for their own use, while simultaneously providing information and skill development around hereditary cancer risk assessment.

While we have identified several topic areas where the Bring Your Brave resources can enhance residency curriculum, the most significant is hereditary cancer. Utilizing the Campaign to develop physician communication skills, increase empathy for patients’ experiences, challenge biases, and deepen subject matter knowledge.

When these education components are offered and explored, Faculty and Residents showed a significant increase in comfort levels around hereditary cancer conversations with patients. In addition, exploring the Bring Your Brave campaign highlights and reinforces the critical role that family medicine physicians play in risk assessment and reduction for their patients. The combination of higher comfort levels and awareness of the role that family physicians play on the front line of hereditary cancer diagnostics has proven to increase the desire and the actuality of faculty and residents increasing the frequency of their risk assessment conversations in practice.    

Data and Results

Explore the results for the following sections in our Collaborative Report.

  • Narrative Medicine      
  • Hereditary Cancer Risk Assessment      
  • Genetic Testing
  • Participants Bring Your Brave Resources – Impressions      
  • Barriers to using Bring Your Brave resources with patients and potential solutions.
  • Utilizing Bring Your Brave in Residency Training    

Collaborative Report


Hereditary Cancer Clinic Resource Folder

As one of the final action period activities, collaborative participants were asked to take the first steps in incorporating the Bring Your Brave Campaign resources in patient care. To address some of the barriers to using the resources, namely lack of knowledge and process uncertainty, participants were asked to create a draft outline for a Clinic-Specific Hereditary Cancer Resource Folder. We asked participants to include guides, procedures, and resources for healthcare providers to refer to and to identify resources to share with patients.

This exercise proved educational, requiring staff to source and compile folder assets and to determine policies and procedures, including the referral process, to use while navigating patients through their hereditary cancer journey. A Hereditary Cancer Resource Folder Template, with outline and sample documents, was developed for this exercise. Download the Hereditary Cancer Resource Folder- Sample Documents & Outline.     

Phase Two - QI Pilot Project

In Phase Two of the project, The Family Medicine Education Consortium (FMEC) has partnered with the National Association of Chronic Disease Directors (NACCD) on a cancer prevention and early detection quality improvement (QI) pilot project funded by the Centers for Disease Control and Prevention.  Learn more about Phase Two   


Thank you to our Funders, Advisory Committee and Resident Program Participants

The FMEC’s project, Helping Families Communicate about Hereditary Breast or Ovarian Cancer, is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) through the National Association of Chronic Disease Directors (NACDD) (Grant/Cooperative Agreement Number 5-NU38OT000286-05).

Learning Collaborative Advisory Committee

  • Tracey Conti, MD, Chair, Department of Medicine, University of Pittsburgh School of Medicine and UPMC
  • Philip G. Day, PhD, Assistant Professor and Associate Director of Education, Department of Family Medicine and Community Health, UMass Medical School
  • Susanna Evans, MD, Associate Professor and Chair, Family, Community, and Preventive Medicine, Temple Health Chestnut Hill, Drexel University College of Medicine
  • Adam E. Perrin, MD, Associate Professor of Family Medicine and Faculty Co-Director, Student Affairs, UConn School of Medicine

Participating Residencies