Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk
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Existing high-risk clinic models focus on patients with known risk factors, potentially missing many high-risk patients. Here we describe our experience implementing universal risk assessment in an ambulatory breast center.
Since May 2017, all breast center patients completed a customized intake survey addressing known breast cancer risk factors and lifestyle choices. Patient characteristics, family history, risk scores, and lifestyle factors were examined; patients with high-risk breast lesions were excluded. Patients were considered at increased risk by model thresholds Gail 5-year risk > 1.7% (35–59 years), Gail 5-year risk > 5.5% (≥ 60 years), or Tyrer–Cuzick (T–C) v7 lifetime risk > 20% (any age).
From May 2017–April 2018, there were 874 eligible patients—420 (48%) referred for risk assessment (RA) and 454 (52%) for non-specific breast complaints (NSBC). Overall, 389 (45%) were at increased risk of breast cancer. Gail 5-year risks were similar between RA and NSBC patients. However, RA patients more frequently met criteria by T–C score (P = 0.02). Of all patients at increased risk, 149 (39%) were overweight (BMI > 25) or obese (BMI > 30) and only 159 (41%) met recommended exercise standards. NSBC patients who met criteria were more frequently smokers (8% vs 1%, P < 0.01); all other demographic/lifestyle factors were similar among high-risk patients regardless of referral reason.
Universal risk assessment in a comprehensive breast health center identified 45% of our population to be at increased risk of breast cancer. This clinical care model provides a unique opportunity to identify and address modifiable risk factors among women at risk.
KeywordsBreast cancer Risk assessment High-risk program Modifiable risk factors Prevention
This research is funded by a grant from the Susan G. Komen foundation.
Compliance with ethical standards
Conflict of interest
JA Suskin reports stock ownership in Pfizer, Thermo Fisher, and Danaher (owned by immediate family members). JE Garber reports a consultant/advisory role for Helix Genetics. TA King reports a consultant/advisory role for Genomic Health. None of these affiliations influenced this work. All other authors report no conflicts.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The study was approved by the Brigham and Women’s Hospital Institutional Review Board as a low risk study and approved with waiver of consent.
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