CancerIQ joined the nation’s leading experts in breast health last month at the National Consortium of Breast Centers’ 31st Annual Interdisciplinary Breast Center Conference. This year’s conference emphasized program development, particularly for managing high-risk patients and reducing disparities in care, and attendees swapped best practices for breast cancer prevention, early detection and survivorship.
Our team walked away with insight into the challenges breast centers are facing in 2022 — as well as some tried-and-true strategies to get ahead. Here are three themes we heard at NCoBC 2022:
1. Breast programs are stretched thin, but tech and risk-based screening can help increase capacity. Health systems around the country are working through the backlog of patients who missed or delayed screenings due to the pandemic. Plus newly proposed guidelines — including universal genetic testing for breast cancer patients and expanded screening for all women at age 30 — mean higher patient volumes could be here to stay.
In two presentations on hereditary cancer screening guidelines, Kent Hoskins, MD, director of the hereditary cancer program at the University of Illinois Cancer Center, discussed barriers to expanded screening. Dr. Hoskins highlighted health systems’ limited capacity to meet the need for high-quality post-test counseling. He recommended using a hybrid, risk-based approach to expand clinician capacity in the short-term. Michele Settelmyer, a high-risk clinic APRN at OSF St. Francis Medical Center, also highlighted capacity challenges in her presentation on technology for high-risk programs. Both Settelmyer and Dr. Hoskins agreed the longer-term solution to capacity challenges might be IT platforms for risk-based screening and care management. In her presentation, Settelmyer shared how OSF HealthCare leveraged CancerIQ’s screening tools, clinical decision support and care management capabilities to expand screening and grow its oncology service lines.
2. Automated risk-stratification makes high-risk programs more sustainable. Many presentations touched on the transition away from one-size-fits all screening guidelines to a more tailored approach. For example, Dr. Hoskins discussed evolving guidelines for patients with variants in the CDH1 gene, which is associated with hereditary diffuse gastric cancer syndrome. New recommendations suggest tailoring patient prevention plans based on family history, in addition to genetic information, to prevent over- and under-treament within this patient population.
While a more risk-based approach to screening promises to improve patient outcomes, keeping up with constantly changing guidelines can be onerous for clinical teams. This was the case at OSF HealthCare’s breast center, which serves more than 30,000 patients and identifies over 400 new cancer diagnoses each year. In a presentation on how to build a comprehensive high-risk breast program, Settelmyer shared how the switch to automated risk screening and stratification in 2016 helped the health system drive a seven-fold increase in genetic counseling appointments.
3. Comprehensive, closed loop solutions can help improve equity and outcomes. As breast centers move toward risk-based screening and personalized prevention plans, manual processes present too many opportunities for patients to fall through the cracks. Care pathways get complex fast, and factors like unconscious bias can result in significant disparities in care and health outcomes. For example, Dr. Hoskins called out the stark disparity in genetic testing between Black and white women, which is due in part to racial differences in provider recommendations.
Settelmyer also touched on the challenge of inconsistent patient messaging, which led to wide variations in delivery across OSF’s patient population. To combat this, OSF launched a comprehensive, closed loop high-risk program, designed to connect patients to screening plans based on their personal level of risk. Bolstered by CancerIQ’s precision health platform and in-house genetics training for staff, OSF increased access to genetic testing through point-of-care screening and virtual consults. OSF nearly doubled screening rates and saw a seven-fold increase in genetic counseling for high-risk patients.