Abstract P3-10-12: Breast cancer risk assessment and evaluation of risk-based screening practices by primary care providers: A single institution experience
Authors: Igid HP , Payne JD , Sultan A , Kow SY , Hobart KL , Payne TN , Jones C 
Published: February 2018

Background: Risk reduction intervention for primary prevention of breast cancer (BC) with tamoxifen, raloxifene, exemestane, and anastrazole has been well studied in high risk women. Despite this established risk reduction strategy, chemoprevention (CP) remains underutilized. In this retrospective chart review, we describe the utilization of BC risk assessment, prevention awareness, and adherence to BC screening recommendations among primary care providers in Internal Medicine (IM), Family Medicine (FM), and Obstetrics and Gynecology (OB) in our institution.

Methods: A total of 1220 electronic charts of women aged ≥35 and ≤78 who came for preventive visits in 2014 (n=1076, OB; n=59, IM; n=80, FM) were reviewed. Charts were evaluated for pertinent histories related to BC risk assessment. Gail scores were calculated for all patients based on available histories with conservative estimates in those with incomplete data recorded. Screening compliance with annual or biennial mammography was recorded.

Results: The percentage of patients having adequate histories in the chart to allow calculation of Gail score was 56.9% in OB, 9.4% in FM, and 1.7% in IM, χ2(2)=131.08, p&lt;0.001. Age at menarche was not documented in 29.5% of OB patients, 56.5% of FM patients, and 94.5% of IM patients, χ2(2)=123.78, p&lt;0.001. Age at first live birth or parity was not documented in 17.8%, 85.9%, and 97.7% of OB, FM, and IM patients respectively, χ2(2)=286.89, p&lt;0.001. Calculation of the Gail score yielded a total of 149 patients (12.2%) who are considered high-risk and potentially eligible for CP. No patients were offered CP as part of their care. IM physicians had significantly higher adherence to BC screening recommendations by NCCN, ACS, and USPSTF (55.36%-81%) compared with OB (45.74%-68.3%), and FM physicians (45.88%-68.6%), (p&lt;0.001). No patients had documented risk-based BC screening even among those found to be high-risk.

Differences between low vs high-risk patients by Gail score  High Risk (Gail ≥ 1.67  Total (n=1220)Yes (n=149)No (n=1071)pGail score, M (SD)1.101 (0.68)2.36 (0.86)0.82 (0.37)&lt;0.001Age, M (SD)48.51 (9.17)56.74 (7.99)47.36 (8.73)&lt;0.001Age at 1st mammogram, M (SD)45.13 (7.77)49.15 (7.69)44.41 (7.56)&lt;0.001Age at menarche, M (SD)12.62 (1.49)12.36 (1.49)12.65 (1.48)0.105Age at first live birth, M (SD)24.34 (5.85)26.39 (6.37)24.06 (5.73)&lt;0.001Number of first degree relatives with history of BC, n (%)   &lt;0.00101036 (84.9)55 (36.9)981 (91.6) 1143 (11.7)84 (56.4)59 (5.5) 29 (0.7)8 (5.4)1 (0.1) Unknown32 (2.6)2 (1.3)30 (2.8) History of breast biopsy, n (%)   &lt;0.001No1150 (94.3)128 (85.9)1022 (95.4) Yes64 (5.3)21 (14.1)43 (4) Unknown6 (0.5)0 (0)6 (0.6) Number of biopsies   0.021157 (89.1)16 (76.2)41 (95.4) 27 (10.9)5 (23.8)2 (4.7) P-value compares two groups based on Gail score cutoff (≥1.67).

Conclusions: BC risk assessment, risk-based screening, and use of BC chemoprevention is not adequately practiced by primary care providers. Primary care providers' adherence to BC screening recommendations was closest to USPSTF guidelines (68.3% to 81.1%) and did not follow risk-based screening recommendations. Rates of adherence to chemoprevention and mammogram screening recommendations approximated national data.

Citation Format: Igid HP, Payne JD, Sultan A, Kow SY, Hobart KL, Payne TN, Jones C. Breast cancer risk assessment and evaluation of risk-based screening practices by primary care providers: A single institution experience [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-12.