Implementing a Population-based Breast Cancer Risk Assessment Program

Abstract Background Personalized breast cancer risk assessment is important in identifying and managing women at increased risk for breast cancer. However, there has been little evaluation of the practical aspects of implementing a population-based program that identifies and refers high risk patients for further evaluation. Materials and Methods We implemented a semi-automated approach to collect personal and family history to identify women at high risk of breast cancer. Based on survey, women identified as elevated risk received letters inviting them to telephone consultations with licensed breast health genetic counselors (BHGCs). High risk women’s history was verified and counseling and referrals provided, as appropriate. Results Among 20,558 women screened, 2,000 (9.7%) women were identified as high risk based on patient initial report. However, the majority (1,580) were excluded from receiving risk communication after BHGC review of risk information with the woman or because of prior attention to breast cancer risk or an abnormal mammogram. Among 420 subjects who received risk letters, 225 received a BHGCs consultation. Of these 225 women, 63 were reclassified as average risk, 158 were referred to high risk clinics and 5 consultations were incomplete after determining that further information was needed. Of the 158 subjects referred to high risk breast clinics, 51 attended an appointment. Conclusion This study highlights the complex nature of a population-based breast cancer screening program in a clinical setting and demonstrates the substantial effort needed to identify newly discovered women at high risk for breast cancer and refer them to appropriate services.