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

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

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.

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Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research is funded by a grant from the Susan G. Komen foundation.

Author information

Authors and Affiliations

  1. Comprehensive Breast Health Center, Brigham and Women’s Hospital, Boston, MA, USA

    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. King

  2. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Anna Weiss, Samantha Grossmith, Danielle Cutts, Sage A. Mikami, Johanna A. Suskin, Negui Arilis Rojas, Eileen Joyce, Esther Rhei & Tari A. King

  3. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Anna Weiss, Esther Rhei, Rochelle Scheib, Brittany Bychkovsky, Judy E. Garber & Tari A. King

  4. Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA

    Lydia E. Pace & Daniel Morganstern

  5. Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA

    Rochelle Scheib, Brittany Bychkovsky, Judy E. Garber & Daniel Morganstern

  6. Starling Physicians Group, Hartford Healthcare Cancer Institute, Plainville, CT, USA

    Daniel Morganstern

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  1. Anna Weiss
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  2. Samantha Grossmith
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  3. Danielle Cutts
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  4. Sage A. Mikami
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  8. Lydia E. Pace
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  10. Esther Rhei
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  13. Judy E. Garber
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  15. Tari A. King
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Corresponding author

Correspondence to Tari A. King.

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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.

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Weiss, A., Grossmith, S., Cutts, D. et al. Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk. Breast Cancer Res Treat 175, 229–237 (2019). https://doi.org/10.1007/s10549-018-05116-5

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