Introduction: Breast cancer is the second most common cancer after skin cancer and the second leading cause of death of women in the United States after lung cancer. Can we identify women, living here in Ohio, who are at increased risk for breast cancer development who at the time of their screening mammogram complete a cancer risk assessment (CRA)? Ohio presents unique challenges to cancer risk factors specific for age, obesity, opioid overdoses, and breast cancer mortality rates.
- To operationalize the Breast High-Risk Cancer Prevention Program/Clinic.
- To provide individualized, streamlined, and specialized management for patients identified at high risk for breast cancer development.
- To expand our Summa Health breast services while maintaining the highest level of quality breast care.
- To improve overall population health in the Akron and surrounding community by targeting cancer prevention and earlier diagnosis.
Methods: Assessment using a personal and family history at the time of screening mammography was implemented in August 2017. The CRA identifies individuals at elevated risk for breast cancer with a score of ≥20%. Patients identified at elevated risk are followed by the high-risk nurse navigator and offered referral for individualized high-risk management in the clinic. High-risk management may include:
- High-risk screening 3-D mammogram and MRI
- Clinical breast exam every 6 months
- Genetic counseling/testing
- Healthy lifestyle behavior modifications—diet, exercise, smoking cessation, alcohol, and hormones
- Prophylactic surgery
Results: In August 2017, the CRA was implemented at the first screening site. It was expanded to include all 8 screening sites in 2018. To date, over 30,000 risk assessments have been completed.
Since August 2017, over 3000 high-risk patients have been identified with the implementation of the CRA completed at the time of a screening mammogram. Individuals scoring a ≥20% lifetime risk have been identified as needing high-risk follow-up and individualized management.
High-risk management for at-risk individuals can impact earlier cancer detection, reduce and prevent mortality, and reduce the incidence of breast cancer.
Conclusion: Educating providers and patients of the benefits of CRA risk assessment and identification of high-risk patients can impact population health here in Ohio. The CRA has the potential to impact breast cancer prevention and earlier detection for patients found to be at ≥20% lifetime risk. Navigation and follow-up of these patients is an opportunity for nursing to impact and educate patients and healthcare providers about cancer risk and the benefits of high-risk management.
- Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice. 2003;10(2):125-143.
- Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822-848.
- Carlson LE, Brown KW. Validation of the mindful attention awareness scale in a cancer population. J Psychosom Res. 2005;58:29-33.
- Kligler B, Homel P, Harrison LB, et al. Cost savings in inpatient oncology through an integrative medicine approach. Am J Manag Care. 2011;17:779-784.
- Klinger B, Homel P, Harrison LB, et al. Impact of the Urban Zen initiative on patients’ experience of admission to an inpatient oncology floor: a mixed-methods analysis. J Altern Complement Med. 2011;17:729-734.
- Resnick B, Jenkins LS. Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res. 2000;49:154-159.
- Schmitz KH, DiSipio T, Gordon LG, Hayes SC. Adverse breast cancer treatment effects: the economic case for making rehabilitative programs standard of care. Support Care Cancer. 2015;23:1807-1817.
- Sisk A, Fonteyn M. Evidenced-based yoga interventions for patients with cancer. J Clin Oncol. 2016;20:181-186.
- Stout N, Binkley JM, Schmitz KH, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012;118:(8 Suppl):2191-2200.
- Urban Zen Integrative Therapy Program. http://uzit.urbanzen.org.
- Advisory Board. www.advisory.com/research/oncology-roundtable/service-plan/survivorship.
- Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/breast.htm.
- National Institutes of Health. Ohio Opioid Summary. https://www.drugabuse.gov/opioid-summaries-by-state/ohio-opioid-summary.