Ready, Set, GO GAIL Project Phase I: Identification of Patients at High Risk for Breast Cancer.
Authors: C. Salm-Schmid, J. Hoehn, V. Ruetten
Journal: Cancer Research (2009)

Abstract Breast cancer is a leading cause of death among women and is second only to heart disease, so prevention of breast cancer should be elevated to a comensurate level of importance. Prevention of breast cancer is not the same as screening, but these words have become synonymous. Mammography is an objective target for screening and is easily trackable, but prevention of breast cancer can be so much more. Armed with new information about the role of exercise, weight, alcohol consumption, breast MRI, and prevention agents, we developed a model for the identification and prevention of breast cancer: The Ready, Set, GO GAIL Project. Prevention information does not seem to be getting into the hands of the people best suited to address prevention: the primary care providers. The Gail model was chosen to identify risk since no other model has undergone as much scrutiny (Baker, Cancer, 1982). With the use of the Gail model, a high risk population can be identified, and opportunities for intervention can be initiated. Our primary goal in phase I was to:1. Engage a primary care group to screen for risk factors for breast cancer2. Provide information on the prevention of breast cancer3. Develop a process for identification of patients at high risk for breast cancer using the Gail Model.Design: After education of staff and providers with multiple sessions, providers were encouraged to think of the Gail model similar to taking a blood pressure measurement- an indicator of risk. Sixteen providers at the Women's Center at Aurora BayCare Medical Center began screening women, ages 35-69, using the Gail model at the time of their annual exam. Patients were considered high risk if their 5 year was &amp;gt;1.7% or lifetime risk &amp;gt; 20%. Providers were only used at the decision making point. Data was collected on the number of patients undergoing an annual exam, number with a calculated Gail risk, number considered high risk with a Gail risk &amp;gt;1.7% or a lifetime risk &amp;gt;20%. Interventions were reviewed in the chart.Results: From May of 2007 to May of 2008, 5512 women were screened, 5724 Gail models were performed because providers started calculating Gail models on patients not just getting their yearly exam. Compliance with the initiative was &amp;gt;100%. Of those patients screened, 13% were high risk. Patients identified as high risk and &amp;gt;40 yrs of age all underwent screening mammography within 12 months of their annual exam (100%). Increases in referrals for genetic counseling, the comprehensive breast center, and breast MRI were noted.Discussion: Prevention should be addressed by primary care providers including breast cancer. The Ready, Set, GO GAIL Project shows that an effective program can be developed to identify women at high risk for breast cancer. Education and a streamlined approach is essential. Mammographic screening rates &amp;gt;90% are rare. Our mammographic screening rate in the high risk population was 100% as the additional information likely motivated both the physician and the patient to overcome barriers. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4010.