Assessing Breast Cancer Risks to Improve Care for an Increased-Risk Population within Eastern North Carolina

Area of Science:

• Oncology
• Public Health
• Genetics

Background:

• Breast cancer risk varies significantly among American women, with an average lifetime risk of 12.5%.
• Risk modeling is a standard of care for screening and prevention, utilizing factors like age, family history, and breast density.
• Rural areas, particularly in North Carolina, face resource limitations hindering consistent application of standard breast cancer risk assessment protocols.

Purpose of the Study:

• To implement and assess a quality improvement project for breast cancer risk stratification in a rural Eastern North Carolina population.
• To evaluate the effectiveness of an evidence-based risk assessment tool and customized intervention services for elevated-risk women.
• To determine the prevalence of hereditary breast and ovarian cancer risks within the study population.

Main Methods:

• A quality improvement project was conducted over one year at a community hospital, screening 4500 women.
• The Tyrer-Cuzick tool quantified individual breast cancer risk, stratifying women into risk management groups.
• National Comprehensive Cancer Network (NCCN) guidelines were used to assess hereditary cancer risks, with local genetics extenders facilitating testing.

Main Results:

• 14.4% of screened women were identified as high-risk (≥20% lifetime risk) or above-average risk (15%-20% lifetime risk).
• 20% of unaffected women met NCCN guidelines for hereditary breast and ovarian cancer testing, irrespective of their general cancer risk score.
• Targeted interventions, including additional imaging and risk-reduction programs, were developed for elevated-risk women.

Conclusions:

• The implemented model successfully improved breast cancer risk assessment and testing in a rural community hospital setting, addressing a critical community need.
• A significant proportion of women were found to have elevated breast cancer risk and a higher percentage were candidates for genetic testing.
• These findings suggest that improved risk stratification and individualized management can help mitigate breast cancer outcome disparities observed in certain regions.