Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
J Cancer Policy. 2022 Dec;34:100354. doi: 10.1016/j.jcpo.2022.100354. Epub 2022 Aug 19.
To estimate lifetime risk of breast cancer among women utilizing mobile mammography and to determine the proportion that might benefit from additional services, such as genetic counseling and educational programs.
Retrospective analysis of electronic health records for 2214 women screened for breast cancer on a mobile mammography van was conducted. Participants answered questions about their demographic characteristics, breast health, and family history of cancer. Logistic regression analyses were used to assess the odds of being recommended for additional services by the Tyrer-Cuzick (TC) lifetime risk score.
The average TC ten-year risk score was 2.76 % ± 2.01 %, and the average TC lifetime risk score was 7.30 % ± 4.80 %. Using lifetime risk scores ≥ 10 %, it was determined that 444 patients (20.23 %) could be referred to additional services. Less than one percent of patients had been tested for the BRCA genes previously. The odds of being recommended for additional services by the TC model were significantly greater among those who were eligible for the New York Cancer Services Program (i.e., a proxy for lack of insurance) when compared to those who were ineligible (OR=1.31, 95 % CI: 1.03-1.66). After adjustment, screening borough and race/ethnicity were not significantly associated with being recommended for services.
Genetic counseling and education are some of the tools available to promote awareness and early detection of breast cancer; however, screening guidelines do not mandate genetic counseling or referrals for individuals at high-risk.
Patients and providers should have discussions about predicted TC lifetime risk scores at follow-up breast cancer screening appointments, as this is a missed opportunity to improve care at both fixed sites and mobile clinics.
利用移动乳房 X 光检查来估计女性患乳腺癌的终生风险，并确定可能受益于额外服务（如遗传咨询和教育计划）的比例。
对在移动乳房 X 光检查车上接受乳腺癌筛查的 2214 名女性的电子健康记录进行回顾性分析。参与者回答了有关其人口统计学特征、乳房健康和癌症家族史的问题。使用逻辑回归分析评估 Tyrer-Cuzick（TC）终生风险评分推荐额外服务的可能性。
TC 十年风险评分平均为 2.76%±2.01%，TC 终生风险评分平均为 7.30%±4.80%。使用终生风险评分≥10%，确定 444 名患者（20.23%）可以转诊接受额外服务。之前有不到 1%的患者接受过 BRCA 基因检测。与不符合条件的患者相比，符合纽约癌症服务计划（即缺乏保险的代理）的患者被 TC 模型推荐接受额外服务的可能性显著更高（OR=1.31，95%CI：1.03-1.66）。调整后，筛查行政区和种族/族裔与被推荐接受服务无显著相关性。
遗传咨询和教育是提高乳腺癌意识和早期发现的工具之一；然而，筛查指南并未规定对高风险个体进行遗传咨询或转诊。
患者和提供者应在乳腺癌筛查后续预约时讨论预测的 TC 终生风险评分，因为这是改善固定站点和移动诊所护理的错失机会。
