Implementation in a large health system of a program to identify women at high risk for breast cancer

Abstract

Purpose: PATIENTS AT HIGH RISK FOR DEVELOPING BREAST CANCER CAN BE IDENTIFIED USING A VALIDATED PREDICTIVE TOOL: the Gail model. Patients thus identified can undergo careful breast cancer screening and be considered for preventive measures, such as chemoprevention with tamoxifen or raloxifene. An organized health system can create a screening and high-risk intervention program for breast cancer and potentially save lives and resources. Multiple components of the health system must work together in a multidisciplinary manner to successfully implement such a program.

Methods: Aurora Health Care is a large health system in Wisconsin. In 2007, a medical center within Aurora initiated a program to identify patients at high risk for developing breast cancer and intervene with screening and prevention. The program used the Gail model, which was administered to patients presenting for comprehensive physical examination at the women's center.

Results: During the first year, 5,718 Gail model scores were calculated, and 15.2% of patients were deemed high risk. Most were counseled by their primary care providers, and few underwent screening with magnetic resonance imaging, genetics consultation, or chemoprevention. Primary care providers expressed concerns regarding the accuracy of the Gail model, the additional time necessary for patient counseling, how few patients underwent chemoprevention, and perceived medicolegal risk. The program was altered to address these concerns.

Conclusion: Success of a breast cancer risk and intervention program in a large health system is more likely if concerns of participating disciplines are acknowledged and addressed.