Systematic genetic risk assessment for breast cancer patients in a community oncology practice

Abstract

22172 Background: In order to increase the identification of patients at risk for hereditary cancers, we developed a systematic genetic risk assessment process for breast cancer patients presenting to oncology services in a multi-center cancer program. Methods: Over a six-month period (September 2006-February 2007), detailed family history forms were provided to both new and returning breast cancer patients at three offices in a community oncology practice. Data from the completed forms were used to generate a four-generation pedigree. The pedigrees were analyzed by a certified genetic counselor and, using published criteria, placed into high, moderate or average risk categories for several hereditary cancer syndromes. Letters summarizing the assessments were sent to the treating oncologists, noting recommendations for referral to genetic services. Oncologist use was then tracked by referral patterns and random chart review for action taken on the information. Satisfaction survey data was obtained through focus groups with participating oncologists and nurses. Results: Of the 548 forms provided, 427 (77.9%) were completed and 117 (27.4%) were assessed at “High Risk” for a hereditary cancer syndrome. Forty-four of the high risk breast cancer syndrome patients (44/98, 45.0%) were referred for genetic counseling services 1 year post provision of genetic assessment. Twenty-five charts were randomly reviewed for oncologist action. Charts from 8/13 (61.5%) of the high or moderate risk patients noted referral for genetic services to date. Significant variation was noted between providers. Satisfaction surveys and focus groups supported continuation of the program, with streamlining and liability as areas of concern. Conclusions: Nearly 1/3 of breast cancer patients in this practice were classified as high risk for an hereditary cancer syndrome. Our intervention was associated with increased referrals for high risk patients as compared to previously published reports. Satisfaction with the process was high among providers and patients alike. Optimal translation of family history information into clinical interventions will require increased efficiency, provider buy-in, development of clinical systems, and quality controls. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Minnesota Affiliate of the Susan G. Komen for the Cure