Abstract P2-12-06: Implementing a comprehensive genetic risk assessment and testing service at an outpatient breast imaging center
Authors: Wilson K , Sweeney L 
Published: August 2014

Breast cancer is the most common cancer in women, and there are a variety of available methods to determine which women have an above-average risk to develop breast cancer. However, it can be a challenge to identify patients who may benefit from genetic counseling and should be offered genetic testing. This study examines our data and experience in performing genetic risk assessment and offering on-site genetic counseling in an outpatient breast imaging center. A screening questionnaire asking about personal and family cancer history was created and given to every patient coming in for either screening or diagnostic mammogram. The questionnaires were reviewed by both the breast radiologist and nurse navigator, and those identified as appropriate were offered appointments with the genetic counselor. Genetic counseling appointments are available two days per month. Data was obtained over an eight month period from August 2012- March 2013. During this time, 8768 mammograms were performed and 406 individuals were identified as having a history suspicious for hereditary breast and ovarian cancer and offered an appointment with a genetic counselor. Out of these 406 individuals, 83 scheduled appointments with the genetic counselor, 108 declined appointments, and 215 are pending. Some of the genetic counseling appointments were made after March 31, 2013 and the outcomes are not included at this time. Thirty-six patients were ultimately seen for genetic counseling and risk assessment in this time frame, with 28 undergoing testing. Out of the 28 patients tested during this time period, one was positive and one had a variant of unknown significance. Out of the 36 patients seen for genetic counseling, 27 were identified as increased risk for breast cancer either by having a Gail risk assessment score ≥1.67% or Tyrer-Cuzick risk assessment score ≥19.5% and were eligible for chemoprevention or breast MRI, respectively. This clinic model demonstrates that on-site genetic counseling is feasible in an outpatient breast imaging setting. Prior to offering on-site genetic counseling, this center used the same questionnaire to identify patients and sent a recommendation for genetic counseling to the referring physician ordering the mammogram. This system relied on the physician to make a referral to an off-site genetic counselor. From the period of May 2012- August 2012, 139 patients were identified by the same questionnaire with 17 patients being referred to genetic counseling, and only 3 of these patients were ultimately seen by the genetic counselor. By providing on-site genetic counseling, the percentage of patients seen for genetic counseling increased from 2.15% (3/139) to 8.87% (36/406). In addition, more outcomes are known since 100% of patients identified to be at risk for Hereditary Breast and Ovarian cancer were offered genetic counseling, and if a patient declined, a reason was documented. The risk assessment algorithm outlined here identified more patients that either tested positive for a BRCA mutation or were at an increased 5-year or lifetime risk to develop breast cancer that may not have been detected otherwise.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-06.