ASPO Abstracts
Breast Cancer Risk Notification in the Mammography Screening Population: A Pilot Study
Category: Behavioral Science & Health Communication
Conference Year: 2019
Abstract Body:
Purpose of the Study: To explore the impact of breast cancer (BC) risk notification on usage of risk appropriate BC management strategies among women at ≥20% lifetime risk.Methods: Women presenting for screening mammography underwent BC risk stratification as part of routine clinical care. Estimated lifetime risk was computed using the modified Gail, Tyrer-Cuzick (TC7), and BRCAPRO models. Numerical risk information was sent to referring providers via the electronic medical record. Women at high (≥20%) risk based on any stratification model (N=298) received a mailed letter with categorical risk information and American Cancer Society recommendations for supplemental screening MRI. A subset of high risk women consented to a follow-up study (n=71). Follow-up is ongoing; 34 women have completed the 6 month follow-up assessment. Outcomes of interest included (a) patient recall of risk and (b) receipt of screening breast MRI.Results: Participants were 52 (±8) years of age, 74% were non-Hispanic White, 79% had ≥college education, and 77% had private health insurance. Six months after their screening mammogram, 23 women (68%) recalled receiving a letter with risk stratification information and 12 (35%) correctly recalled their risk level. Since the time of screening mammography, 6 women (18%) reported receiving a physician recommendation for breast MRI and 3 (9%) received a breast MRI. Of those women who received a breast MRI, 2 (67%) reported that their breast MRI was recommended by the provider who had referred them for their screening mammogram.Conclusions: This pilot study demonstrates that conducting risk stratification at the time of screening mammography is feasible. However, the majority of patients did not correctly recall the risk information provided. In addition, few high risk women reported physician recommendation for or receipt of risk-concordant management strategies (i.e., supplemental screening MRI). This may be due to the follow-up time point selected; extended follow-up is necessary to understand usage of risk-management strategies. In addition, future research should improve risk communication, with the ultimate goal of increasing risk appropriate BC management.
Keywords: breast cancer; risk stratification; screening