Use of a Standardized Tool to Identify Women at Risk for Hereditary Breast and Ovarian Cancer

Abstract

ObjectiveTo increase rates of identification and genetic counseling referral for women at risk of hereditary breast and ovarian cancer (HBOC). DesignEvidence-based practice improvement initiative. Setting/Local ProblemPrivate suburban obstetric and gynecologic (OB/GYN) practice in Tennessee with no standardized process for HBOC risk assessment or referral to genetic services. ParticipantsProvider-led women's health care teams delivering well-woman care for women ages 18 years and older. Intervention/MeasurementsWe implemented the use of a standardized familial risk assessment tool and clinical decision-making algorithm. Preimplementation and postimplementation risk identification and genetic services referral rates were measured, as was clinicians’ compliance with using the risk assessment tool. The aim of the initiative was to increase identification and referral rates by 25 percentage points. ResultsWomen at risk of HBOC in the postimplementation group were 25.9 times more likely to be identified as being at risk (OR = 25.88, 95% confidence interval [10.78, 62.14]) and 31.5 times more likely to be offered referral to genetic counseling (OR = 31.50, 95% CI [13.37, 74.22]) compared with those in the preimplementation group. Rates of risk identification and referral to genetic counseling for women at risk of HBOC improved by 58.2 and 69.3 percentage points, respectively, surpassing the aims of this initiative and showing statistical significance of p < .001 for both indices. ConclusionThe use of a standardized risk assessment tool and process for HBOC risk identification and genetic referral resulted in a significant increase in the identification and referral of women at risk in this setting. Early identification of women with HBOC is a crucial first step in increasing the use of enhanced screening and interventions that can reduce HBOC-associated cancer morbidity and mortality.