Personalized Breast Cancer Risk Assessment: Incorporation of Genetic and High-Risk Factorson Breast Cancer Risk and Management

1516 Background: Breast cancer risk assessment (RA) is rarely performed in the primary care setting due to uncertainty regarding the balance of harms and benefits in high risk women subsequently offered chemoprevention. We used a decision model to assess the potential clinical impact of several strategies involving use of routine RA in primary care. Methods: We developed a decision analytic model to compare routine breast cancer RA in primary care to usual care. The RA method was the Gail model, with a 5-year risk of >1.67% being designated as high risk (varied in sensitivity analyses). We assumed that high risk women would be offered 5 years of tamoxifen and that acceptance (70%) and compliance (68%) rates would be incomplete. For women receiving tamoxifen, the relative risk (RR) of incident estrogen-receptor positive invasive breast cancer was 0.31 over the 5 years of treatment, diminishing over the next 5 years after cessation of treatment. RR’s for the other health effects associated with tamoxifen were: vertebral fracture (0.74), endometrial cancer (2.41), stroke (1.6), pulmonary embolism (PE, 3.01), and deep vein thrombosis (DVT, 1.60). The non-breast cancer health effects of tamoxifen were assumed to pertain only to the 5 years of active therapy. All RR’s were applied to age-dependent population-based incidence rates; data sources included published epidemiologic and clinical trial data; model duration was 40 years. Results: In agreement with recommended clinical use of tamoxifen, the results were sensitive to age and the Gail threshold above which chemoprevention was recommended ( Table ). The number of women needed to screen (NNS) to prevent 1 case of breast cancer is 7-fold higher among women aged 50 compared to 65 with a Gail risk of 1.67% (719 vs. 104). Conclusions: The number of women offered treatment, as well as the clinical outcomes and NNS, resulting from routine breast cancer risk assessment varies with the age at RA and treatment threshold selected. [Table: see text] No significant financial relationships to disclose.

Download Full-text

Short-term outcomes of implementation of a computer-based breast cancer risk assessment program during screening mammography.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.298 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 298-298

Author(s):

Debra Ray ◽

Sherry Grumet ◽

Portia Lagmay-Fuentes ◽

Lolita Jacob ◽

Annette Terzo ◽

...

Keyword(s):

Breast Cancer ◽

Risk Assessment ◽

High Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Life Time ◽

Screening Mammography ◽

Cancer Risk Assessment ◽

Breast Cancer Risk Assessment ◽

High Risk Clinic

298 Background: Major barriers to high risk breast cancer risk assessment include inadequate documentation of family history, complexity of risk calculation and model selection, and lack of awareness. We have established a high risk breast cancer assessment program using a computer-based real time risk calculation at time of screening mammography. Objectives were to facilitate identification of high risk patients needing genetic counseling/testing and MRI breast screening. Methods: Beginning 11/23/2010, prior to screening mammogram all patients completed a self reported risk assessment using a wireless tablet. With real time risk calculation for risk of genetic mutation (Myriad and BRCAPRO models) as well as life time risk of breast cancer (Gail, Claus, Tyrer-Cuzick, and BRCAPRO models) using HughesRiskApps patients were categorized into high risk ( ≥ 10% gene mutation risk or ≥ 20% life time breast cancer risk) or average risk groups and received a risk assessment letter. The risk data was integrated into mammography information system (Penrad) simultaneously. High risk patients were contacted by a coordinator to facilitate high risk clinic evaluation. Results: As of June 30, 2012, 24,213 patients without a cancer history completed HRA; 2,196 patients (9.1%) have been identified as high risk- for genetic mutation 1,051 pts, (4.3%), life time risk 1,570 pts, (6.5%), and both risks 425 pt, (1.8%). 416 patients (18.9%) of those high risk patients have been evaluated in the high risk clinic. 231 patients have been evaluated by genetic counselor and 97 have had genetic testing and 9 with positive results (9.3%). Yearly screening breast MRI has been recommended to 254 patients. Conclusions: We have successfully implemented breast cancer risk assessment through screening mammography service. Results suggest that 9.1% of our patients can benefit from high risk clinic assessment and 4.3% should have consideration for gene mutation testing. 6.5% of our patients may benefit from screening breast MRI. We strive to improve the number of patients who proceed with high risk clinic assessment by education of our patients regarding benefits of screening and risk reducing strategies.

Download Full-text