Risk Assessment Increases Mammography Use in High-Risk Women

A recent article published in JAMA Network Open highlights the positive impact of individual cancer risk assessment on a patient undergoing mammography screening.

Screening mammography saves lives. In fact, in the last 25 years, 40% fewer women have died from breast cancer. However, differences still exist across racial and ethnic groups, with a higher percentage of Black and Hispanic women dying from breast cancer compared to women who are non-Hispanic White.

Several studies indicate these differences exist due to delayed diagnosis and more advanced breast cancers at the time of diagnosis. This difference is primarily due to skipping or delaying screening mammography.

The article states, “Public health initiatives and advances in cancer research aim to reduce screening mammography disparities among racial and ethnic minority women. Strategies that improve screening mammogram uptake are opportunities to promote equity at a population level. Scalable solutions include breast cancer risk assessment programs to inform patients about their risk and the role of screening mammography in reducing breast cancer mortality.”

Cancer risk assessment is calculated for the vast majority of female patients at Elizabeth Wende Breast Care (EWBC) as part of their annual screening. We collect the data needed for this risk assessment on our detailed health history form. This assists our doctors, and clinical staff in customizing screening recommendations based on the outcome of the risk assessment. These recommendations could include adding supplemental screening ultrasound, or screening breast MRI (Magnetic Resonance Imaging), and identifying patients who may be a candidate for genetic counseling and testing. These recommendations are shared on the patient’s mammogram report and sent to referring providers for review.

Sharing this information helps better engage patients in conversations with their providers about their risk level, the appropriate age to begin screening, and which tests are most appropriate. The results of a cancer risk assessment can be overwhelming and challenging to understand. Having a conversation with a trusted medical professional about these results creates an opportunity to ask questions and learn what actions can be taken.

The recent study found that 52.1% of patients were at average risk and 47.9% at high risk for developing breast cancer. In addition, 60.6% of the patients self-identified as African American, 37.2% as Hispanic, and 2.1% as other racial and ethnic groups. A nonsignificant increase in screening mammography uptake was found, from 38.6% during usual care to 48.7% after risk breast cancer risk assessment. Additional analysis found a significantly higher rate of newly identified high-risk women having screening mammography after learning their risk status (51.1% vs. 36.6%).

This is evidence that cancer risk assessments can change patients’ behavior and increase their likelihood of beginning screening at the appropriate age. We hope that women, especially Black and Hispanic women, will begin having conversations with their medical providers about their individualized cancer risk and use this information to guide them to appropriate screening recommendations. This advancement alone can save lives and decrease the health disparities surrounding a breast cancer diagnosis.

If you have questions about your cancer risk assessment, please contact our high-risk/genetics department at (585) 758-7050.
Are you part of a medical practice seeking to implement cancer risk assessment into your workflow? Our providers routinely provide training for existing medical practices and assist them in implementing a risk assessment program.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784055 

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