ASPO Abstracts
Breast Cancer Risk Management Following Universal Risk Stratification: Impact of Risk Communication on High-Risk Clinic Visits, Chemoprevention, Genetic Counseling, and Genetic Testing
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose of the Study: To characterize uptake of breast cancer (BC) risk management behaviors
(i.e., high-risk clinic visits, chemoprevention, genetic counseling, and genetic testing) following
BC risk stratification among women identified as high risk for BC.
Methods: Women presenting for screening mammography underwent BC risk stratification during
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 in
conjunction with screening mammography results. Women at high (≥20%) risk based on any
stratification model (N=298) received a mailed letter with categorical risk information and contact
information for the institution’s high risk breast clinic. A subset of high risk women consented to a
follow-up study (n=71); 66 (93%) completed a survey to assess BC risk management behaviors 6
months post-mammogram.
Results: Participants were 52 (±8) years old, 89% were non-Hispanic White, and 74% had private
health insurance. Since the time of screening mammography, 7 patients (11%) reported any BC
risk management behaviors. Six (9%) reported receiving a referral to a high-risk clinic, 5 (8%)
scheduled a high-risk clinic appointment, and 4 (6%) attended a high-risk clinic appointment.
Although recommended to 5 participants (8%), only 1 participant (2%) initiated primary
chemoprevention medication. Finally, 9 participants (14%) discussed genetic counseling with a
healthcare provider, 6 (9%) were referred for genetic counseling, and 3 (5%) completed genetic
testing. Of those who completed genetic testing, 2 participants had received their results
(BRCA1/2 negative=1, variant of uncertain significance=1).
Conclusions: Few women reported uptake of BC risk management behaviors following risk
stratification. In particular, the rates of high-risk chemoprevention and genetic testing observed in
this study are lower than previously reported. This may be due to the follow up time point
selected; extended follow-up is necessary to understand uptake of risk management strategies in
high risk women unaffected by BC. These pilot data indicate that universal risk stratification alone
may not lead to increased utilization of BC risk management behaviors.
Keywords: breast cancer; risk stratification; risk reduction