Abstract P4-10-13: Screening and risk reducing surgeries for patients at high risk for breast and ovarian cancer at an integrated care setting
Authors: Ter-Minassian M , Visvanathan K , Jefferson CR , Schaeffer ML , Suwannarat P 
Published: May 2019

Background: Current US guidelines recommend more intensive screening and preventive strategies for patients with a known pathogenic germline mutation or a high lifetime risk based on breast cancer risk prediction models. The American Cancer Society, for example, recommends that yearly mammogram alternating with MRI screening should be considered as early as 30 years old in women with a lifetime breast cancer risk of &gt; 20%. Furthermore, NCCN recommends that BRCA1/2 mutation carriers consider additional risk-reducing strategies, including bilateral mastectomy, bilateral oophorectomy at age 35, or post-child bearing, and hormonal chemoprevention. It is unclear what the uptake of screening and risk reducing strategies are after an HRBROC assessment and recommendations by Genetics at an integrated care setting.

Methods: We retrospectively studied female patients diagnosed as high risk for breast and ovarian cancer (HRBOC) (regardless of prior cancer) and/or tested for BRCA mutations by a genetic counselor or physician geneticist at Kaiser Permanente Mid-Atlantic States (KPMAS) Genetics clinics between 2005-2016. We identified cancer diagnoses, mammogram and MRI screening, mastectomies and oophorectomies with ICD diagnosis or CPT procedure codes during the study period. We defined prophylactic mastectomy or prophylactic oophorectomy as occurring either 180 days prior to, or without a diagnosis of breast or ovarian cancer respectively. We assessed screening with a mammogram or MRI, post Genetics visit for patients 30-75yrs old at time of HRBOC dx, and had no breast cancer prior to, or within 180 days, of the Genetics visit.

Results: Our cohort included 813 women with a HRBOC diagnosis, with a median 51 yrs of age at diagnosis, 45% White, 38% Black and 15% other race. Since genetics services for cancer at KPMAS were established recently, 98% of visits occurred after 1-1-2013. Table 1 shows the distribution of cancer diagnoses and surgeries pre and post Genetics visit. 249 Breast cancer-free patients were screened post Genetic visit between mid-2013-2016: 159 (64%) had at least 1 screening test, 68 had two to three and only 3 women had four to six screening tests. The median time to the latest screen after HRBOC dx was 14.4 mo, (range 2 days to 39 mo). Post-Genetics screening frequency did not differ by race.

Conclusion: The majority of women visited Genetics after a diagnosis of breast or ovarian cancer. Patients received prophylactic oophorectomies more often than prophylactic mastectomies. Screening in cancer free patients with a HRBROC diagnosis appears to be limited to 1-3 screens post diagnostic visit. Our findings suggest that earlier detection of patients at high risk for breast and ovarian cancer and closer monitoring is needed.

Table 1.Cancer diagnoses and Surgeries Pre and Post Genetics Visit for HRBROC (2004-2016) (N=813) pre-Geneticspost-GeneticsTotalBreast Cancer diagnosed51314527Post cancer Mastectomy3198327Prophylactic Mastectomy314Ovarian Cancer diagnosed55257Post cancer oophorectomy40343Prophylactic oophorectomy632689

Citation Format: Ter-Minassian M, Visvanathan K, Jefferson CR, Schaeffer ML, Suwannarat P. Screening and risk reducing surgeries for patients at high risk for breast and ovarian cancer at an integrated care setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-13.