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Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk

  • Anna Weiss
  • Samantha Grossmith
  • Danielle Cutts
  • Sage A. Mikami
  • Johanna A. Suskin
  • Mary Knust Graichen
  • Negui Arilis Rojas
  • Lydia E. Pace
  • Eileen Joyce
  • Esther Rhei
  • Rochelle Scheib
  • Brittany Bychkovsky
  • Judy E. Garber
  • Daniel Morganstern
  • Tari A. KingEmail author
Epidemiology
  • 80 Downloads

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Breast cancer Risk assessment High-risk program Modifiable risk factors Prevention 

Notes

Funding

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.

Ethical approval

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.

Informed consent

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.

Supplementary material

10549_2018_5116_MOESM1_ESM.pdf (117 kb)
Supplementary material 1 (PDF 116 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anna Weiss
    • 1
    • 2
    • 3
  • Samantha Grossmith
    • 1
    • 2
  • Danielle Cutts
    • 1
    • 2
  • Sage A. Mikami
    • 1
    • 2
  • Johanna A. Suskin
    • 1
    • 2
  • Mary Knust Graichen
    • 1
  • Negui Arilis Rojas
    • 1
    • 2
  • Lydia E. Pace
    • 1
    • 4
  • Eileen Joyce
    • 1
    • 2
  • Esther Rhei
    • 1
    • 2
    • 3
  • Rochelle Scheib
    • 1
    • 3
    • 5
  • Brittany Bychkovsky
    • 1
    • 3
    • 5
  • Judy E. Garber
    • 1
    • 3
    • 5
  • Daniel Morganstern
    • 1
    • 4
    • 5
    • 6
  • Tari A. King
    • 1
    • 2
    • 3
    Email author
  1. 1.Comprehensive Breast Health CenterBrigham and Women’s HospitalBostonUSA
  2. 2.Division of Breast Surgery, Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Breast Oncology ProgramDana-Farber/Brigham and Women’s Cancer CenterBostonUSA
  4. 4.Division of Women’s HealthBrigham and Women’s HospitalBostonUSA
  5. 5.Division of Cancer Genetics and PreventionDana-Farber Cancer InstituteBostonUSA
  6. 6.Starling Physicians GroupHartford Healthcare Cancer InstitutePlainvilleUSA

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