Genetic risk assessment in women with breast cancer in the outpatient setting: Establishing the standard of practice for ambulatory care clinics

Abstract

1039 Background: Recognizing the importance of genetic information on the practice of oncology, ASCO has established guidelines for incorporating genetic information into clinical practice. The objective of this study was to assess how reliably genetic information is collected and used in practice. We identified and studied a population at risk of having an underlying genetic predisposition to cancer in the Kansas City metropolitan area. Methods: Chart audits on 210 women diagnosed with breast cancer at the KCCC clinics seen between January and February of 2002 were conducted by oncology nurses. All audited patients were under the age of 65 and were not currently undergoing chemotherapy treatment. A pedigree risk management tool was developed to examine the completeness of the family cancer history recorded, the frequency with which the patients were assessed for hereditary cancer risk, and the frequency with which they were considered for genetic counseling services. Results: Of the 210 charts reviewed, 85.5% of the charts audited had family history information of which 65.4 % reported 3 generations of family history while 14.5 % had no mention of family history. With respect to cancer risk management, 60.8 % reported risk management plans of which 9.8% required genetic counseling. The findings are summarized in the table below. Conclusion: These results suggest that a more careful assessment of hereditary cancer risk needs to be incorporated into medical practice. To improve access to genetic counseling for patients, we recommend that a family history questionnaire be incorporated into clinical practice as well as availing nurse practitioners and clinicians with educational programs designed to educate health practitioners on how to incorporate genetic information into clinical practice. No significant financial relationships to disclose.