Setting Goals for a High Risk Breast Care Program
With over 300,000 new cases a year, breast cancer is the most common cancer diagnosis for women.1 Finding breast cancer early and receiving state-of-the-art cancer treatment are the most important strategies to decrease deaths from breast cancer.2 Everyone carries some risk for breast cancer, and those with family histories or inherited genetic mutations have significantly increased lifetime risks.
The Role of Breast Centers
Breast centers have an integral role in improving outcomes for patients with breast cancer—early tumor detection and evidence-based care gives patients the best chance for long term survival. While mammographic screening is recommended to start at age 40 for women at average risk, some patients are at higher risk for cancer than others. For those high risk patients, it is recommended that they begin screening sooner. Imaging centers with high risk breast programs can help identify those high risk patients to discuss surveillance options and to offer genetic testing. For patients with a breast cancer diagnosis, comprehensive breast care programs can provide prompt treatment.
Once a patient has received a high risk genetic result, they are more likely to receive insurance coverage for more advanced imaging technology, such as breast MRI and to participate in more frequent screening. This additional screening helps high risk individuals catch cancer earlier, when there is a higher likelihood of a successful outcome.3
A high risk breast program that includes hereditary cancer testing can improve care and can help those at risk to better understand their options. Getting started with a high risk screening program doesn’t have to be complicated and growing a high risk breast program can help centers reach business goals. For imaging centers working to build a high risk breast program, setting goals can help identify successes and areas for improvement as you grow your business.
Setting and Measuring Goals
Genetic testing is just one component of a high risk breast care program, and when implemented it has the potential to be a strong driver of growth while also improving patient outcomes. Other activities, such as ongoing staff education, multidisciplinary patient management, partnership with surgeons, and best practices for screening and pathology are all important pieces of building a comprehensive program.
For any goal, identifying metrics to track can help validate investments and improve processes for long term breast center success. Develop baselines and track them over time by recording metrics such as number of patients that complete a medical history questionnaire, what risk levels they are, whether they complete genetic testing, and whether they return for more frequent imaging services. Services like NateraCore can help breast centers track which patients engage in these activities to make reporting easier, while providing comprehensive support to get a genetic testing program off the ground.
Below are a few common goals that can be easily tracked:
1. Screen More Patients for Family Cancer Patterns
Identifying those patients at high risk for breast cancer starts with taking a personal and family medical history. When centers increase the number of histories collected, they identify more high risk patients that can benefit from more comprehensive screening. 1 in 3 patients will qualify for hereditary cancer testing based on their history,4 and up to 90% of these patients will not have received screening.2 Furthermore, 85% of patients that have already been diagnosed with breast or ovarian cancer haven’t had genetic screening.5 Of those screened, 9% will carry a genetic variant that increases their risk for cancer.6 Another 40% will have a high risk Tyrer Cuzick score,6 qualifying them for more frequent and more advanced screening such as breast MRI.
Digital programs can help you save time in identifying those patients who could be at increased risk for hereditary cancer based on their personal and family history. NateraCore supports integration with a range of digital solutions for streamlined history collection, including Natera’s Educational Virtual Assistant(NEVA), Volpara health system, and the PenRad Genetic Risk Management System. By asking patients to answer a few questions in the comfort of their home before their scheduled visit, these platforms make it easy to screen even more patients for hereditary cancer risk .
With NEVA, by following a series of prompts, patients can complete their personal and family health history on their computer or smartphone. When a patient meets medical guidelines for hereditary cancer testing, a notification is sent to your office via email or fax. With both the Volpara and PenRad management systems, while you are collecting health history information for their visit, a patient is flagged as ‘high risk’ if they meet medical guidelines. If you are already using these systems, there is no need to change your workflow. If you would like to get started with one of these platforms at your center, Natera can help.
2. Offer Testing to More Patients with At Risk Histories
An area for potential measurement is encouraging those who are at risk to progress from screening to testing. When offered the same day as a family history risk assessment, those at risk are more than twice as likely to complete hereditary cancer testing.7
As part of the risk assessment process, breast centers can help increase the number of people participating in genetic testing by making it easier to sign up for screening. One of the most common objections to same day genetic testing is a lack of time.6 When utilizing an at-home family history collection system, like NEVA, at-risk patients can be identified before their appointment and notified that testing will be available at the time of their appointment. NateraCore also offers a range of mobile phlebotomy services to support sample collection at your facility, in your patient’s home, or at lab collection centers nationwide.
Often, patients with complex family histories of cancer are referred to genetic counseling before being offered testing. In some areas these services are difficult to access, and it can lead to patients who could benefit from increased screening falling through the cracks. Breast centers can help these patients connect with testing faster by walking them through the National Comprehensive Cancer Network’s testing guidelines, or by using convenient virtual counseling services. Natera’s Certified Genetic Counselors can help imaging centers by offering complimentary telehealth genetic information sessions before, during, and after testing, regardless of a patient’s risk status or screening results.
By collecting cancer histories, and offering testing as well as genetic counseling as part of a regular workflow, breast centers can increase the number of patients that are tested. Patients identified as high risk are more likely to return for more frequent imaging screening.
3. Increase Screening Rates and Early Interventions
Receiving a high risk result from hereditary cancer test like Empower can qualify patients for insurance coverage for more frequent screening and advanced imaging like breast MRI. A high risk result also encourages high-risk patients to keep their recommended screening schedule. Breast centers can see increased revenues and returns on their equipment investments, while high-risk patients are more likely to have their cancer caught and treated earlier. Keeping track of which patients return for regular screening after screening as high risk can help a breast center demonstrate the value of their family history screening and genetic testing programs.
For many patients, early interventions will save lives. Results from genetic testing can help providers encourage additional screenings and can help those at risk make informed decisions about prophylactic or risk-reducing surgery (such as mastectomy) and preventive medications (such as tamoxifen).8,9 Intervention adoption is another metric worth measuring. Even successful high risk breast clinic, clinicians often experience low follow through on clinical recommendations.10
NateraConnect, our online provider portal, offers options to track patient results, screening adherence, and intervention adoption in a convenient and intuitive interface.
4. Enhance Reporting and Identify Areas for Quality Improvement
Collecting and sharing data on genetic screening, along with established screening modalities (e.g., mammography, MRI), as part of a high risk program can help your imaging center evaluate your center’s role in improving early detection and outcomes. The data provided through electronic medical record (EMR) integrations, such as those supported with the EmpowerTM Hereditary Cancer Test and NateraCore, provide additional qualitative metrics that imaging centers can use to support program benchmarks and to inform quality improvement.
Natera Can Help
Natera offers customized support to breast centers working to incorporate Empower Hereditary Cancer Testing and NEVA into their workflow. Follow this link to learn more about getting started with Empower or incorporating hereditary cancer screening into an existing high risk breast cancer program.
References
1https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed January 2022.
2Knerr S. et al. 2019. Trends in BRCA Test Utilization in an Integrated Health System, 2005-2015. J Natl Cancer Inst. 111(8):795-802. doi: 10.1093/jnci/djz008.
3National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. https://seer.cancer.gov/statfacts/html/breast.html. Accessed February 2022.
4Couch FJ, Shimelis H, Hu C, et al. Associations Between Cancer Predisposition Testing Panel Genes and Breast Cancer. JAMA Oncol. 2017;3(9):1190-1196. doi:10.1001/jamaoncol.2017.0424
5Childers C. et al. 2017. National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer. J Clin Onc. 35(34): 3800-3806.
6Loving et al. A Breast Radiology Department-operated, Proactive Same-day Program Identifies Pathogenic Breast Cancer Mutations in Unaffected Women. Academic Radiology, Volume 29, S239 - S245
7DeFrancesco M. et al. 2018. Hereditary Cancer Risk Assessment and Genetic Testing in the Community-Practice Setting. Obstet Gynecol 132(5):1121-1129.
8National Comprehensive Cancer Network: Guidelines for Genetic/Familial Risk Assessment: Breast and Ovarian. Version 2.2019-July 30, 2018.
9https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/pdf/screening_ct_guidelinesF.pdf. Accessed January 2022.
10Implementation of a High Risk Breast Clinic for Comprehensive Care of Women With Elevated Breast Cancer Risk Identified by Risk Assessment Models in the Community. Alison Laws and Therese M. Mulvey. JCO Oncology Practice 2021 17:2, e217-e225.