Abstract P4-13-13: Risk Assessment and Personalized Decision Support: The University of California Athena Breast Health Network

Abstract

Abstract Background: The Athena Breast Health Network is a University of California (UC) initiative to drive rapid innovation in patient-centered prevention, screening, and treatment of breast cancer. Athena is a collaborative of the five UC medical centers and UC Berkeley that integrates clinical care and research, rapidly mobilizing data and research to enable continuous improvement in patient care and outcomes. The first initiative of Athena was to implement risk assessment for women being screened for breast cancer and to offer tailored referrals for women found to be at increased risk of developing breast cancer. Methods: Patients who enroll in Athena complete an electronic questionnaire to collect personal and family history data prior to their mammography screening visit. These data are used to generate multiple risk assessments using the NCCN and USPSTF guidelines, and BCRAT (Gail model). Data on established breast cancer risk factors such as chest wall radiation and history of hormone replacement therapy are also collected and used to identify women at potentially increased risk. Upon enrollment, women are given the opportunity to provide a blood or saliva sample for research purposes. Women who meet Athena-defined criteria that identify them to be at increased risk receive a referral to a Breast Health Specialist (BHS). The BHS identifies individual patient needs for prevention and screening services, including genetic counseling and testing, provides referrals to a High Risk Breast Clinic or nurse practitioner, and conducts lifestyle modification counseling. BHS have special training in breast cancer risk assessment, and some are licensed genetic counselors. Primary care and/or referring providers are directly informed of risk assessment results through mailings or the electronic medical record. Results: The recruitment goal enrollment for Athena is 150,000 and to date more than 17,000 women have been enrolled across the five centers. Of those enrolled, 32% indicated that they have a family history of cancer. 56% of the cohort consented to participate in research, and 40% provided a biospecimen for research purposes. Across the five centers, 32 educational outreach sessions about Athena were held, reaching approximately 375 providers. Conclusion: Successful implementation of the Athena risk assessment and decision support process will enable the identification of high risk women who are most likely to benefit from tailored screening or risk reducing interventions and who otherwise may not have been referred for risk reducing measures. By identifying women at the highest risk and connecting them to screening and prevention resources, the Athena Breast Health Network aims to ultimately reduce the incidence of breast cancer in its participant cohort. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-13.