Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA.
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Cancer Res Treat. 2019 May;175(1):229-237. doi: 10.1007/s10549-018-05116-5. Epub 2019 Jan 21.
Existing high-risk clinic models focus on patients with known risk factors, potentially missing many high-risk patients. Here we describe our experience implementing universal risk assessment in an ambulatory breast center.
Since May 2017, all breast center patients completed a customized intake survey addressing known breast cancer risk factors and lifestyle choices. Patient characteristics, family history, risk scores, and lifestyle factors were examined; patients with high-risk breast lesions were excluded. Patients were considered at increased risk by model thresholds Gail 5-year risk > 1.7% (35-59 years), Gail 5-year risk > 5.5% (≥ 60 years), or Tyrer-Cuzick (T-C) v7 lifetime risk > 20% (any age).
From May 2017-April 2018, there were 874 eligible patients-420 (48%) referred for risk assessment (RA) and 454 (52%) for non-specific breast complaints (NSBC). Overall, 389 (45%) were at increased risk of breast cancer. Gail 5-year risks were similar between RA and NSBC patients. However, RA patients more frequently met criteria by T-C score (P = 0.02). Of all patients at increased risk, 149 (39%) were overweight (BMI > 25) or obese (BMI > 30) and only 159 (41%) met recommended exercise standards. NSBC patients who met criteria were more frequently smokers (8% vs 1%, P < 0.01); all other demographic/lifestyle factors were similar among high-risk patients regardless of referral reason.
Universal risk assessment in a comprehensive breast health center identified 45% of our population to be at increased risk of breast cancer. This clinical care model provides a unique opportunity to identify and address modifiable risk factors among women at risk.
现有的高风险诊所模式侧重于具有已知风险因素的患者，可能会遗漏许多高风险患者。在此，我们描述了在门诊乳腺中心实施通用风险评估的经验。
自 2017 年 5 月以来，所有乳腺中心患者均完成了一项针对已知乳腺癌风险因素和生活方式选择的定制入组调查。检查了患者特征、家族史、风险评分和生活方式因素；排除了具有高风险乳腺病变的患者。通过模型阈值，将患者定义为具有较高风险：盖尔 5 年风险>1.7%（35-59 岁），盖尔 5 年风险>5.5%（≥60 岁）或 Tyrer-Cuzick（T-C）v7 终生风险>20%（任何年龄）。
2017 年 5 月至 2018 年 4 月，共有 874 名符合条件的患者-420 名（48%）因风险评估（RA）就诊，454 名（52%）因非特定乳腺投诉（NSBC）就诊。总体而言，389 名（45%）患者有较高的乳腺癌风险。RA 和 NSBC 患者的盖尔 5 年风险相似。但是，RA 患者更频繁地符合 T-C 评分标准（P=0.02）。所有处于高风险的患者中，有 149 名（39%）超重（BMI>25）或肥胖（BMI>30），只有 159 名（41%）符合推荐的运动标准。符合标准的 NSBC 患者更频繁地吸烟（8%比 1%，P<0.01）；无论转诊原因如何，高风险患者的所有其他人口统计学/生活方式因素都相似。
在综合性乳腺保健中心进行通用风险评估发现，我们人群中有 45%的人有较高的乳腺癌风险。这种临床护理模式为识别和解决高危女性的可改变风险因素提供了独特的机会。
