Breast Cancer Res Treat. 2019 Jan 21. doi: 10.1007/s10549-018-05116-5. [Epub ahead of print]
Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk.
Weiss A1,2,3, Grossmith S1,2, Cutts D1,2, Mikami SA1,2, Suskin JA1,2, Graichen MK1, Rojas NA1,2, Pace LE1,4, Joyce E1,2, Rhei E1,2,3, Scheib R1,3,5, Bychkovsky B1,3,5, Garber JE1,3,5, Morganstern D1,4,5,6, King TA7,8,9.
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.
Breast cancer; High-risk program; Modifiable risk factors; Prevention; Risk assessment