Making the Case for a High-Risk Breast Program

Oct 19, 2021

It’s 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% based on the Tyrer-Cuzick model. She perceives that number to be low and doesn't act on it, 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 entire life, forcing invasive surgeries and/or aggressive treatments with a long list of side effects, which in turn disrupt her work, family, and social relationships and have significant financial consequences. Most of all, it leaves her asking a simple but difficult question:

“Why didn’t anyone catch this sooner?” 

The answer is that the average breast program provides one-size-fits-all preventive care that fails to meet the needs of the 1 in 10 women with the highest risk of a breast cancer diagnosis.

  • Programs should identify which patients carry genetic mutations such as p53, BRCA1, or BRCA2 mutations — not just those with a family history of cancer — as genetic mutations also carry an elevated risk of ovarian, colon, or pancreatic cancer.
  • Programs must be able to understand and assess the multiple clinical pathways for preventive treatment for high-risk patients, including breast MRI, prophylactic surgery, and hysterectomy.
  • Programs need a stronger navigation pathway for patients than a letter in the mail and a note to the primary care physician. The average breast program is not equipped to offer patient care navigation, placing the burden on individual patients to seek care above and beyond what is standard. In the case with the woman in our example, many patients without the appropriate level of healthcare guidance do not seek the right preventive care, only to receive a late-stage diagnosis later in life.

The consequences of this limited approach are stark: There are 1.2 million women in the United States with a family history of breast or ovarian cancer who have yet to undergo a genetic test. And women with a genetic mutation, such as a BRCA mutation, have an 87% lifetime risk of a breast cancer diagnosis, according to a 2015 study, compared to just 13% for women with an average risk.

The best way to help these women is to provide a more personalized and precise approach to breast cancer prevention and treatment. Proactive screening and genetic evaluation help women and their care teams better identify and understand their level of risk. Preventive services that are personalized according to risk level can improve outcomes significantly: High-risk patients with a genetic mutation, such as p53, BRCA1, or BRCA2 mutations, can receive the right care at the right time and achieve outcomes typically seen in low- and average-risk patients.

Our e-book, The Definitive Guide to High-Risk Breast Programs: How a Modern Approach to Design and Implementation Drives Better Clinical and Financial Outcomes offers a roadmap for improving patient care and clinic operations. We included a maturity curve for high-risk breast programs with key metrics so you can assess the effectiveness of your clinic or health system’s current program and identify ways to improve. Common challenges and lessons learned are covered to demonstrate how real practices have built sustainable programs. Finally, we include talking points for OB-GYNs and oncologists working to build the business case for an investment in advancing their high-risk breast program.

We are excited to provide The Definitive Guide to High-Risk Breast Programs: How a Modern Approach to Design and Implementation Drives Better Clinical and Financial Outcomes to our fellow cancer prevention professionals. It will undoubtedly set the stage for long-term stability, resilience, and growth throughout a health system.

Download the brand new ebook here.

Topics: Best Practices| cancer awareness| Breast Centers| Precision Health