Real-Time Breast Cancer Risk Assessment at Screening Mammography

Background: Each woman’s risk of developing breast cancer is different and depends on her lifestyle, family health history, and other factors. The American Cancer Society considers women who have a lifetime risk assessment of 20% or greater to be at high risk for breast cancer.¹

Knowing one’s risk of developing breast cancer enables a woman to develop a personal breast health plan specific to her individual risk. Women who have an understanding about their risk can make informed decisions about preventive, risk management, and breast cancer screening strategies.² Many women remain unaware of their individual breast cancer risk, and often only those women who proactively present with concerns about family history are referred to breast cancer risk assessment programs or for genetic counseling/testing.³ Often, healthcare providers are incognizant of a patient’s personal risk due to a lack of family history, limited awareness about breast cancer risks and assessment, and the complexity of risk calculation.⁴

Breast centers that have studied breast cancer risk assessment at mammography have reported up to 9.9% of women having mammograms as being stratified as high risk.^4,5

Objectives: (1) Identify women at high risk for breast cancer utilizing a computer-based, real-time assessment based on the Gail Breast Cancer Risk Assessment Model; (2) Educate women about breast cancer risk factors and management strategies for improved informed decision-making; and (3) Increase utilization of our risk program or provide a platform for further discussion with healthcare providers.

Methods:

• Survey area breast centers for current practices
• Provide staff education for breast cancer risk assessment and management
• Develop workflow processes and algorithms for practice
• Determine risk assessment reporting methods to patients and healthcare providers
• Develop patient educational information and materials
• Establish measures for patient outcomes and quality improvement
• Develop breast center website information and submit local newspaper article
• Include real-time risk assessment program in the patient satisfaction survey

Results: Within 3 months of implementation, 38 women (4% of the 925 mammograms) were identified as high risk through the real-time risk assessment at screening mammography program. Education was provided by the breast health nurse navigator on breast cancer risk, risk factors, management strategies, and a review of individual breast cancer risks. One-half of the women scheduled an appointment with our breast cancer risk assessment and management program, and one-half of the women opted to discuss it further with their own healthcare provider.

Conclusion: All women screened with mammography had risk assessment scores calculated, which resulted in the identification of 38 women (4%) at high risk for breast cancer. All of these women (100%) received breast cancer risk education and were either streamlined into our breast cancer risk assessment and management program or were given the platform needed for further discussion with their healthcare providers. Referrals to our breast cancer management program have doubled since implementing this program. The mammography exam provided an ideal teachable moment to assess individualized breast cancer risk and inform women of strategies available to them to reduce their risk and to provide them an opportunity to access the breast cancer risk assessment and management program. Expanding our program with the utilization of risk assessment tools, which consider risk factors not included in the Gail Model, may increase our efforts. Future studies include those that assess the impact this program has on the number of genetic mutations identified, screening compliance, and on the number and stage of breast cancer patients diagnosed.

References

1. American Cancer Society. American Cancer Society screening recommendations for women at high risk. www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. 2017.
2. Hollingsworth AB, Singletary SE, Morrow M, et al. Current comprehensive assessment and management of women at increased risk for breast cancer. Am J Surg. 2004;187:349-362.
3. Evans DG, Howell A. Can the breast screening appointment be used to provide risk assessment and prevention advice? Breast Cancer Res. 2015;17:84.
4. Ray D, Grumet S, Lagmay-Fuentes P, et al. Short-term outcomes of the implementation of a computer-based breast cancer risk assessment program during screening mammography. J Community Support Oncol. 2014;12:209-211.
5. Plummer L. Breast cancer risk assessment study. Cartersville Medical Center Breast Imaging Center of Excellence. http://cartersvillemedical.com/service/breast-cancer-risk-assessment-study. 2017.