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Longitudinal adherence to breast cancer surveillance following cancer genetic testing in an integrated health care system

  • Epidemiology
  • Published:
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Abstract

Purpose

Screening with mammography and breast magnetic resonance imaging (MRI) is an important risk management strategy for individuals with inherited pathogenic variants (PVs) in genes associated with increased breast cancer risk. We describe longitudinal screening adherence in individuals who underwent cancer genetic testing as part of usual care in a vertically integrated health system.

Methods

We determined the proportion time covered (PTC) by annual mammography and breast MRI for individuals with PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, and ATM. We determined time covered by biennial mammography beginning at age 50 years for individuals who received negative results, uncertain results, or with PVs in genes without specific breast cancer screening recommendations.

Results

One hundred and forty individuals had PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, or ATM. Among these individuals, average PTC was 48% (range 0–99%) for annual screening mammography and 34% (range 0–100%) for annual breast MRI. Average PTC was highest for individuals with PVs in CHEK2 (N = 14) and lowest for individuals with PVs in TP53 (N = 3). Average PTC for biennial mammography (N = 1,027) was 49% (0–100%).

Conclusion

Longitudinal screening adherence in individuals with PVs in breast cancer associated genes, as measured by the proportion of time covered, is low; adherence to annual breast MRI falls below that of annual mammography. Additional research should examine screening behavior in individuals with PVs in breast cancer associated genes with a goal of developing interventions to improve adherence to recommended risk management.

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Data Availability

Enquiries about data availability should be directed to the authors.

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Acknowledgements

This work was supported by the Clinical Sequencing Evidence-Generating Research (CSER) consortium funded by the National Human Genome Research Institute with co-funding from the National Institute on Minority Health and Health Disparities (NIMHD) and the National Cancer Institute (NCI). The CSER consortium represents a diverse collection of projects investigating the application of genome-scale sequencing in different clinical settings including pediatric and adult subspecialties, germline diagnostic testing and tumor sequencing, and specialty and primary care.

Funding

This work was primarily supported by the National Institutes of Health: U01HG007292 (MPIs: Wilfond, Goddard), U24HG007307 (PI: G. Jarvik); K08HG010488 (PI: S. Knerr).

Author information

Authors and Affiliations

  1. Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98195, USA

    Sarah Knerr & Beth Devine

  2. Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA

    Boya Guo

  3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Karen J. Wernli

  4. Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA

    Kathleen F. Mittendorf, Marian J. Gilmore, Kristin R. Muessig, Jamilyn M. Zepp & Katrina A. B. Goddard

  5. Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Kathleen F. Mittendorf

  6. Institute for Health Research, Kaiser Permanente, Denver, CO, USA

    Heather Spencer Feigelson

  7. Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA

    Gail P. Jarvik

  8. Kaiser Permanente Center for Health Research, Portland, OR, USA

    Tia L. Kauffman, Erin Keast, Elizabeth G. Liles & Frances L. Lynch

  9. Denver Health and Hospital Authority, Denver, CO, USA

    Sonia Okuyama

  10. Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA

    David L. Veenstra & Beth Devine

  11. Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA

    Benjamin S. Wilfond

  12. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Katrina A. B. Goddard

Authors
  1. Sarah Knerr
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  2. Boya Guo
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  3. Karen J. Wernli
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  16. Benjamin S. Wilfond
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  18. Katrina A. B. Goddard
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Contributions

Conceptualization: SK, BG, KJW, KFM, BD, KABG; Data curation: BG, MJG, EK, JMZ; Formal analysis: SK, BG; Funding acquisition: SK, KJW, GJ, SO, DLV, BSW, KABG, TLK; Project administration: TLK, KRM. Supervision: KJW, KABG, Writing-original draft SK, B.G., KJW, KFM, BD, KABG; Writing-reviewing & editing: SK, BG, KJW, KFM, HSF, MJG, GPJ, TLK, EK, EGL, FLL, KRM, SO, DLV, JMV, BSW, BD, KABG.

Corresponding author

Correspondence to Sarah Knerr.

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Conflict of interest

The authors have no conflicts of interest outside the grant funding listed in the funding section.

Ethical approval

The study was approved by the Kaiser Permanente Northwest Institutional Review Board with a waiver of informed consent.

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Knerr, S., Guo, B., Wernli, K.J. et al. Longitudinal adherence to breast cancer surveillance following cancer genetic testing in an integrated health care system. Breast Cancer Res Treat 201, 461–470 (2023). https://doi.org/10.1007/s10549-023-07007-w

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  • DOI: https://doi.org/10.1007/s10549-023-07007-w

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