ASPO Abstracts
The Role of Primary Care Providers in Breast Cancer Risk Assessment and MRI Referral: A Mixed-Methods Study
Category: Early Detection & Risk Prediction
Conference Year: 2022
Abstract Body:
Purpose: Supplemental screening breast MRI is recommended for women with ‚â•20% lifetime risk of breast cancer (BC). Multiple factors affecting healthcare providers can be a barrier in recommending screening breast MRI to eligible patients. We assessed practice patterns related to breast cancer risk assessment and referral for screening breast MRI among primary care providers (PCPs).Methods: Physicians (MDs and DOs) and nurse practitioners specializing in family medicine, internal medicine, or OB/GYN were recruited through professional organizations. PCPs (N=49) completed an online survey assessing attitudes and behaviors related to BC risk assessment and screening. A subset (n=8, 16%) also completed in-depth individual interviews.Results: To evaluate BC risk, PCPs most often assessed family history (92%) and abnormal mammograms/biopsies (84%). Only 10% reported using mathematical models (e.g., Gail Model, IBIS) that would provide specific BC risk estimates to inform use of MRI. Most PCPs would recommend screening with breast MRI for BRCA1/2 carriers (59%), but fewer (45%) would recommend it for high-risk women without a BRCA1/2 mutation. PCPs based their recommendations on guidelines from ACS (33%), their own institution (16%), or USPSTF (12%). Qualitative analyses identified several themes related to the difficulty of implementing precision BC screening guidelines. Themes were broadly categorized into three categories reflecting the care continuum: (1) identifying high-risk women (e.g., lack of formal systems for risk assessment, scope of practice issues); (2) referral for screening (e.g., conflicting guidelines/recommendations, medico-legal implications); and (3) logistical barriers to getting screening (e.g., scheduling/time, transportation, cost). PCPs suggested that technology (including EMR-based tools) could be used to help overcome some of the barriers identified.Conclusions: PCPs regularly assess elements of BC risk in their clinical practice, but reported limited use of BC risk models. They also reported moderate willingness to refer patients for breast MRI and identified many barriers in this process. Thus, interventions that educate and support PCPs may be needed to increase utilization of breast MRI among high-risk women.
Keywords: breast cancer, early detection, breast MRI, precision prevention