How Breast Centers Can Keep Up with Changing NCCN Guidelines

Oct 24, 2022

Risk models and oncology guidelines are constantly being reviewed and updated as new evidence comes to light. It can be difficult for providers, who are managing a full slate of patients, to keep up to speed with these important changes, especially with the influx of patients throughout the month of October.

The 2022 updates to the National Comprehensive Cancer Network (NCCN) Guidelines for genetics/familial high-risk assessment, for instance, were just updated in September 2022. The update changed breast cancer risk management guidelines for patients with different gene mutations, among other revisions, and ultimately, their eligibility for screenings your breast center offers.

Following the latest clinical guidelines not only ensures patients at an elevated risk of hereditary breast cancer gets the level of care they personally need to prevent cancer, or detect it early, but it can also positively impact your breast center’s financial outcomes. Getting patients in at their earliest eligibility for breast MRIs when recommended can lead to thousands in yearly revenue and lifetime loyalty, and avoid late-stage cancer diagnoses that can lead to patients seeking care outside your network.

Breast center providers including mammography techs, nurses, and clinicians, as well as the patients they serve deserve a tool that helps them follow the most current sets of guidelines without having to disrupt their workflow or retrain staff at each new announcement.

Updated NCCN Guidelines for High-Risk Assessment

NCCN Guidelines are reviewed each year by thousands of multidisciplinary clinicians and researchers. They include recommendations that identify patients who are at high risk of breast cancer who would benefit from genetic counseling and testing, and also give risk management recommendations based on genetic test results.

The September 2022 updates to the NCCN Guidelines for genetics/familial high-risk assessment include changing recommended breast cancer risk management for women with certain gene mutations:

CHEK2 For women with CHEK2 mutation, the new guidance is to consider breast MRI with contrast starting age 30-35, as opposed to age 40.
RAD51C and RAD51D New guidance for RAD51C and RAD51D mutations includes an annual mammogram and consideration of a breast MRI with contrast at age 40.
STK11 mutations STK11 mutations now call for an annual mammogram and breast MRI with contrast starting at age 30.
ATM mutation And updated guidance for an ATM mutation lowers the age of a recommended breast MRI with contrast to age 30-35, from age 40.

Find the most up-to-date NCCN Guidelines for genetics/familial high-risk assessment here (log in required).

Once organizations like the NCCN update their guidance, it’s imperative for providers to also take action. But it can be difficult to track every update made to every risk assessment tool or guideline.

It is an all-too-common scenario in today’s breast centers: A woman who comes in every year for her mammogram fills out an intake form to provide the health system with her family history. A few weeks later, she receives a letter in the mail saying that her lifetime breast cancer risk is above 20% — a number that she perceives to be low and does not
act on even though the Tyrer-Cuzick model recommends that women above that threshold receive additional care such as a breast MRI.

Years later, the woman is diagnosed with late-stage breast cancer. It turns out she was a carrier of the BRCA genetic mutation, meaning she faced a significantly higher risk of a breast cancer diagnosis than the average woman. The diagnosis disrupts her long-term health and wellbeing, forcing invasive surgeries and/or aggressive treatments with a long list of side effects. It also disrupts her work, family, and social relationships and has significant financial consequences. Most of all, it leaves her asking a simple but difficult question: “Why didn’t anyone catch this sooner?”

Excerpt from The Definitive Guide to High-Risk Breast Programs

Identifying patients who are newly eligible for breast MRI and bringing them in for service can not only find cancer in earlier stages, resulting in better outcomes for patients, but it can also generate downstream revenue for health systems. We’ve done the math with our existing partners – breast MRIs can generate $450,000 per 10,000 patients screened, according to CancerIQ’s financial model.

Other Important Breast Cancer Risk Guidelines and Algorithms

While NCCN guidelines are considered the standard of care in oncology, they shouldn’t be used in a vacuum. Other risk assessment and prediction models like the Gail Model, the BayesMendel risk prediction model, the BCSC Risk Calculator, the PREMM5 prediction model, and the Tyrer-Cuzick Lifetime risk model are also invaluable when seeking to identify people at elevated risk of hereditary breast cancer.

Using these tools in tandem can ensure your breast imaging center flags all patients at high risk for developing hereditary breast cancer.

How Breast Centers Can Manage Updated NCCN Guidelines

CancerIQ’s algorithms automate these guidelines and risk models for providers and help them prevent and manage hereditary breast cancer. It is the only tool on the market that integrates Gail, Claus, Tyrer-Cuzick 7 & 8, Bayes Mendel, BCSC model and PREMM 5 directly into the clinical workflow in graphic display.

Breast centers can also manage their patients with CancerIQ. The platform offers templates and customizable messages providers can send to affected patients for follow-up education and actions.

Hear a First-Hand Success Story

Using a combination of the NCCN Guidelines and other risk assessment models to flag all patients who are eligible for genetic testing and earlier screening is how to scale a high-risk breast center program.

In an upcoming webinar, hear directly from Leah Marcantel, RN, a nurse navigator with Christus Ochsner Health Southwestern Louisiana, on how CancerIQ helped her hospital identify high-risk women, put them on a personalized risk management protocol and customized screening plan.


Register for the webinar

Topics: Best Practices| High-Risk Patients| Nurse Navigators| CancerIQ Manager| Breast Centers