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Short-term outcomes of the implementation of a computer-based breast cancer risk assessment program during screening
Debra Ray1, Sherry Grumet, Portia Lagmay-Fuentes
1Leon Hess Cancer Center and Jacqueline M Wilentz Comprehensive Breast Center at Monmouth Medical Center, Long Branch, NJ USA
Background:
Barriers to assessing a patient's risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient's risk for breast cancer at the time of having a mammogram.
Objective:
To facilitate identifcation of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment.
Methods:
Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient's risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation.
Results:
As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identifed as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients.
Conclusions:
We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can beneft from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.
