Is Attendance at a Breast Center Risk Assessment Clinic Improved with a

High Risk Recommendation in the Standardized Mammography Report?!

Ankur Vaidya (1,2); Alison Chetlen, D.O.(3); Susann Schetter, D.O.(3)!
(1) University of Maryland, Baltimore County; (2) SURIP; (3) Department of Radiology, Penn State Milton S. Hershey Medical Center!

INTRODUCTION! RESULTS! DISCUSSION!

Women getting mammograms undergo risk assessment via the Gail Model Total High-Risk Patients There was a significant increase in the high-risk recommendations placed into
which states the percentage of the lifetime risk of developing breast cancer. A the standardized mammography report from 2011 to 2013 with no significant
greater than or equal to 20% lifetime is considered high-risk and additional increase in the number of patients seeking consultation at the risk
screening modalities are recommended1. We established the Penn State Figure 2: Patients Given a High-Risk 414 assessment clinic.!
Hershey Risk Assessment Clinic to closely follow these high-risk women. ! Recommendation in the Mammography
! Report and Underwent Consultation Purposeful avoidance may be responsible in part for this outcome. Patients at
In 2012, breast radiologists implemented standardized reporting with a High-Risk Healthcare Provider! high-risk for breast cancer may experience high levels of psychological
High-Risk ! High-Risk!
distress fearing both the implications of cancer and potential discrimination
173   241  
recommendations for these women. A narrative is inserted into the ! Patients in Patients in
mammography report to the patient’s referring physician. A summary of the There was a significant increase in the from insurance companies or employers because of genetic test results2,3.
2011 2013
report plus a high-risk recommendation in laymen’s terms (lay letter) is sent to number of reports in which a high-risk In our patient population, women travel long distances for their mammograms,
the patient. ! recommendation was inserted into the High-Risk
! and this may be a possible deterrent. We have no data reflecting the referring
We studied whether the institution of this standardized reporting template with mammography report by the radiologist (40.5%)   70   Recommendation in 182   (75.5%)   physician’s communication of our recommendation for risk assessment to the
from the year 2011 to 2013 (p<0.0001, Mammography Report
the high-risk recommendation along with the high-risk patient “lay letters” patient, which may also contribute to low consultation numbers.
improved attendance at our risk assessment clinic. ! chi-square test).! !
Educating patients of their high-risk status, personalizing their care
Patient Does
(11.4%)   8   Subsequent Follow-up with!
High-Risk Provider
26  (14.3%)   accordingly, ensuring accessibility of the risk assessment clinic, and
Patient <20%
Not Follow Up alleviating patient anxiety may improve attendance at our risk assessment
Patient Fills Lifetime Risk!
with High Risk
Out History
Clinic!
clinic4. !
Questionnaire! 90!
Woman High Risk
Status
presents for
Radiologist Annotated in Patient 80!
Screening Recommended
Interprets Mammogram
Mammogram for Bi-Annual 70!
or Diagnostic
Mammogram!
Mammogram! Report that is
sent to
physician!
Visit!
60!
CONCLUSION!
Patient Follows
Patient ≥20%
Up with High
Figure 3: High-Risk Recommendation 50! Implementation of standardized reporting was effective but did not cause the
Lifetime Risk!
Risk Clinic! by Radiologist—Inter-Observer and expected impact in appropriate referrals of women for risk assessment. !
Figure 1: The High Risk High Risk Intra-Observer Variability! 40! !
Assessment Process! Status Not
! Further research is necessary to evaluate the effects of enhanced education
Annotated in 30!
Mammogram Individually, each radiologist increased of the referring physicians and patient population, in addition to the
Report that is
the number of high-risk recommendations 20! importance of the lay letter initiative, to ensure high-risk patients receive
sent to
physician! given to patients from 2011 to 2013.! adequate personal counseling, supplemental screening, and preventative
10!
! treatment. !
0!
2011! 2013! 2011! 2013! 2011! 2013! 2011! 2013!
Radiologist A! Radiologist B! Radiologist C! Radiologist D!
METHODS! ACKNOWLEDGEMENTS!
Total Patients ≥20%! Patients Given High-Risk Recommendation!
A list of patients with a ≥20% lifetime risk by the Gail model from the year 2011 Thank you to Dr. Gail Matters and Dr. Kathy Simon for allowing this opportunity through the SURIP
at Penn State Hershey. Also thanks to Dr. Alison Chetlen, Dr. Susann Schetter, Dr. Meredith Watts,
and 2013 was compiled. Data from 2012 was excluded because it was a
2011 24/70 11/24
Annie Arguin, and the rest of the staff at the Breast Center at Penn State Hershey. Lastly thanks to
transition period with the implementation of our standardized high-risk
recommendation system. Women were older than 35, had no personal history 70 (34.3%) (45.8%)
Zainul Hasanali, my junior mentor.!
Contact Information:!
of breast cancer, and were not already being followed for their high-risk status. Ankur Vaidya!
ankurv1@umbc.edu!
Medical records, breast imaging reports, and histology from breast biopsies Patients who Patients who http://www.linkedin.com/in/vaidyaankur!
Figure 4: High-Risk Recommendation Patients with High-Risk
were examined for each patient to examine whether:! Underwent Underwent a
! and Subsequent Supplemental Recommendation in
Supplemental Subsequent Biopsy
•  The radiologist included a high-risk recommendation in mammography Screening Breast MRI exam ! Mammography Report
Screening Breast MRI for Suspicion on MRI References!
reports! !
1.  Causer, P.A., et al., Breast Cancers Detected with Imaging Screening in the BRCA Population: Emphasis on MR Imaging with Histopathologic
•  Patients received a “lay letter” indicating their high-risk status! Correlation 1. Radiographics, 2007. 27(suppl_1): p. S165-S182. !
2013

•  Patients underwent supplemental screening (MRI) because of high-risk

182 48/182 16/48 2.  Nelson, H.D., et al., Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update
the US Preventive Services Task Force recommendation. Annals of internal medicine, 2014. 160(4): p. 255-266-266.!
3.  Lerman, C. and M. Schwartz, Adherence and psychological adjustment among women at high risk for breast cancer. Breast cancer research and
status! (26.4%) (33.3%) treatment, 1993. 28(2): p. 145-155. !
•  Patients followed up with a high-risk provider! 4.  Hoskins, K.F., et al., Assessment and counseling for women with a family history of breast cancer: a guide for clinicians. Jama, 1995. 273(7): p.
577-585. !