Anna Weiss1,2,3, Samantha Grossmith1,2, Danielle Cutts1,2, Sage A Mikami1,2, Johanna A Suskin1,2, Mary Knust Graichen1, Negui Arilis Rojas1,2, Lydia E Pace1,4, Eileen Joyce1,2, Esther Rhei1,2,3, Rochelle Scheib1,3,5, Brittany Bychkovsky1,3,5, Judy E Garber1,3,5, Daniel Morganstern1,4,5,6, Tari A King7,8,9. 1. Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA. 2. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 3. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. 4. Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA. 5. Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA. 6. Starling Physicians Group, Hartford Healthcare Cancer Institute, Plainville, CT, USA. 7. Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA. Tking7@bwh.harvard.edu. 8. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. Tking7@bwh.harvard.edu. 9. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. Tking7@bwh.harvard.edu.
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.
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, RApatients 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.
Authors: Brittany Bychkovsky; Alison Laws; Fisher Katlin; Marybeth Hans; Mary Knust Graichen; Lydia E Pace; Rochelle Scheib; Judy E Garber; Tari A King Journal: Breast Cancer Res Treat Date: 2022-04-04 Impact factor: 4.624
Authors: Mary C White; Marion Mhel H E Kavanaugh-Lynch; Shauntay Davis-Patterson; Nancy Buermeyer Journal: Int J Environ Res Public Health Date: 2020-01-22 Impact factor: 3.390