Adding Breast Cancer Risk Assessment to Your Practice Benefits Patients

Risk assessment can be a complicated topic when it comes to determining the likelihood an individual woman will develop breast cancer during her life. But, incorporating it into your practice can help you deliver a higher level of patient care, according to an industry expert.

In a Friday session, during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Bethany Niell, M.D., Ph.D., section chief of breast imaging at H. Lee Moffitt Cancer Center in Tampa, outlined what you should consider when trying to integrate risk-assessment into what you already do.

For more Society of Breast Imaging conference coverage, click here.

According to existing data, one in 11 women will develop breast cancer before age 45. If practices can begin risk-based assessment at an early enough age, it may be possible to impact the delivery and efficacy of care, she said. There are several things you need to consider to be successful, however.

Decide what you want to assess: Before proceeding with risk assessment, figure out what you want to focus on, Niell advised. Do you want to concentrate on early detection and supplemental screening, risk-reduction strategies, or genetic counseling? You could do any or all of these.

“Consider it conducting a first pass to identify elevated-risk women who may benefit from formal risk assessment by a high-risk specialist,” she said.

Choose your model: When selecting a risk assessment model, choose one based upon whether you are looking to determine risk of developing breast cancer or risk of having a genetic mutation. Some models can provide both assessments, but Niell offered these suggestions.

While most models are designed to compensate for some level of incomplete data entry, do your best to collect and input the highest quality data you can, she said.

“I cannot emphasize enough that if you are going to perform risk assessment in your practice, collect high quality data,” she said. “Do not expect any of the models to provide you and your patients with accurate risk calculations if you are not inputting complete data.”

Use more than one model: Up to 6 percent of women who undergo screening mammograms have a life-time risk of developing breast cancer of more than 20 percent. Because different model will identify high-risk groups in different ways, always use more than two models to assess your patients, she said, and refer women who are determined to be high risk for further evaluation.

Automate the assessment: With so many patients, taking additional time to conduct and evaluate risk assessment can slow down your workflow. Instead, automate every step of the process. It both decreases the chance of error and alleviates some of your workload. Establish a system that auto-populates the risk estimates directly into the radiology report so that it can be easily reviewed by the referring provider.

Keep communication simple: Although the average American can read at around an 8th-grade level, 20 percent read at a 5th-grade level or below, she said. Be careful to simply your communications as most medical material is written at roughly a 10th-grade level.

“When drafting documents for your patients, remember to target a 5th or 6th grade reading level,” Niell recommended. “There are online tools you can use to help you revise your initial drafts.”

It’s a good idea to have communications designed for patients of both average and elevated risk that are easy-to-read and that can guide patients through their next steps. Be sure you gather input from your patients and referring providers as their thoughts can be helpful on how best to word your communications.

Query your patients: Knowing how your patients prefer to receive their information about risk can also be useful, she said. In a survey of patients in her practice, women of average risk were amenable to written communication informing them. However, high-risk patients preferred verbal communication, making the role of the breast imaging navigator valuable.

Ultimately, she advised, your patients are likely to respond positively to risk-based assessment if you offer it.

“Patients want breast cancer risk assessment but are not receiving it,” she said. “Please consider performing a ‘first-pass’ risk assessment in your breast imaging practice with subsequent referrals for formal risk assessment.”

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