Abstract P5-11-03: Development and implementation of a breast cancer risk identification and reduction program in a large health care system
Authors: MacSweeney Maureen A , Roorda Helen , Lippert Richard , Guardolia Ivy , Burrell Nefertari , DeJesus Luis , Scarletto Augustus J , Decker David A 
Published: May 2015

Background: Multiple national and international organizations (USPSTF, ASCO, NCCN, and NICE) recommend identifying patients at an increased risk of breast cancer and counseling these patients concerning risk reduction strategies. Primary care providers have not complied with these guidelines.To fill this void, we initiated a program which identifies risk and offers risk reduction strategies.This abstract describes the development and preliminary outcomes of this program.

Material and Methods: Florida Hospital has 10 separate mammography center sites. Screening mammograms were performed on 48,917 women the year prior to the start of the program. The program was created to target this population. Data was collected between 4/1/2013 and 3/31/2014. Each of the 10 sites were incrementally added throughout one year. Women at the time of screening mammogram were offered participation in the program by the mammography technician. Mammography technicians were educated and trained. A tablet was developed with our IT department. Women that consented answered 8 questions from the NCI modification of Gail risk, 1 question addressing chest wall radiation, and 5 questions modified from the NCCN Guidelines BR/OV -1 to identify hereditary risk possibly missed by the modified Gail. The results, demographics and referring provider information was collected in a database. Patients and referring provider received letters tailored to their individual risks, by Mammologix, a mammography informatics company. High risk was defined as a modified Gail score of ≥1.7% for a 5 years, &gt;17% lifetime risk, or a positive response to the 5 additional questions. Patients at risk were offered a risk and reduction consultation at our Breast Health Center. Consults were provided by a genetic counselor and/or ARNP. The risk and benefits of intervention were discussed. The referring provider was included in any discussion concerning risk reducing surgery, medication, and follow-up. Patients were referred back to their primary provider for continuing follow-up.

Results: 15,165 women were given a risk questionnaire at the time of screening mammography. 2752 patients opted out. 3243 were high risk by the modified Gail method.1329 were high risk by both the modified Gail and our modified NCCN BC/OV-1 genetic guidelines questions. 14 were high risk due to chest wall radiation. Of the 4044 women at risk, 141 opted to be counseled (3.88%). 29 chose to begin prevention medication. 16 chose counseling regarding their hereditary risk.

FHCI Breast Health Center Data Q1Q2Q3Q4Pts Screened1025143452517344Pts at risk by Modified Gail19629011661569Pts at risk by additional questions5175444355Pts seen in Center by ARNP15151780Pts seen in Center by Genetic Counselor2329Pts treated for Breast Cancer Prevention32110

Conclusion: The program provides a comprehensive breast cancer identification and reduction option to a large number of women. It also provides the primary provider a service and resources regarding breast cancer risk identification and prevention.

Citation Format: Maureen A MacSweeney, Helen Roorda, Richard Lippert, Ivy Guardolia, Nefertari Burrell, Luis DeJesus, Augustus J Scarletto, David A Decker. Development and implementation of a breast cancer risk identification and reduction program in a large health care system [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-11-03.