Population Health in Ohio: The Importance of a High-Risk Breast Cancer Prevention Program

Introduction: Breast cancer is the second most common cancer after skin cancer and the second leading cause of death of women in the United States after lung cancer. Can we identify women, living here in Ohio, who are at increased risk for breast cancer development who at the time of their screening mammogram complete a cancer risk assessment (CRA)? Ohio presents unique challenges to cancer risk factors specific for age, obesity, opioid overdoses, and breast cancer mortality rates.

Objectives:

1. To operationalize the Breast High-Risk Cancer Prevention Program/Clinic.
2. To provide individualized, streamlined, and specialized management for patients identified at high risk for breast cancer development.
3. To expand our Summa Health breast services while maintaining the highest level of quality breast care.
4. To improve overall population health in the Akron and surrounding community by targeting cancer prevention and earlier diagnosis.

Methods: Assessment using a personal and family history at the time of screening mammography was implemented in August 2017. The CRA identifies individuals at elevated risk for breast cancer with a score of ≥20%. Patients identified at elevated risk are followed by the high-risk nurse navigator and offered referral for individualized high-risk management in the clinic. High-risk management may include:

• High-risk screening 3-D mammogram and MRI
• Clinical breast exam every 6 months
• Genetic counseling/testing
• Healthy lifestyle behavior modifications—diet, exercise, smoking cessation, alcohol, and hormones
• Chemoprevention
• Prophylactic surgery

Results: In August 2017, the CRA was implemented at the first screening site. It was expanded to include all 8 screening sites in 2018. To date, over 30,000 risk assessments have been completed.

Since August 2017, over 3000 high-risk patients have been identified with the implementation of the CRA completed at the time of a screening mammogram. Individuals scoring a ≥20% lifetime risk have been identified as needing high-risk follow-up and individualized management.

High-risk management for at-risk individuals can impact earlier cancer detection, reduce and prevent mortality, and reduce the incidence of breast cancer.

Conclusion: Educating providers and patients of the benefits of CRA risk assessment and identification of high-risk patients can impact population health here in Ohio. The CRA has the potential to impact breast cancer prevention and earlier detection for patients found to be at ≥20% lifetime risk. Navigation and follow-up of these patients is an opportunity for nursing to impact and educate patients and healthcare providers about cancer risk and the benefits of high-risk management.

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