Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA.
Ann Surg Oncol. 2024 Oct;31(11):7570-7581. doi: 10.1245/s10434-024-15789-6. Epub 2024 Aug 13.
The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development.
Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines.
A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care.
In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.
国家乳腺癌认证项目（NAPBC）标准最近进行了修订，以促进乳腺癌（BC）风险评估和随后的高危服务转诊。本项目旨在评估作者所在的医疗保障体系中具有 BC 高风险的患者比例，衡量患者对高危服务的兴趣，并确定项目发展资源。
在 2023 年的两周内，对接受乳房影像检查的女性进行了调查。排除了 35 例有 BC 病史或诊断的患者。使用 Tyrer-Cuzick（TC）模型第 8 版计算 BC 风险。高/中危风险定义为 10 年风险 5%或以上，终生风险 15%或以上，或两者兼有。遗传咨询和检测转诊标准基于国家综合癌症网络指南。
共有 257 例患者接受了 TC 风险评估，其中 14.8%（n=38）的 10 年 BC 风险为 5%或以上（考虑内分泌治疗），6.2%（n=16）的终生 BC 风险为 20%或以上（有资格进行年度筛查 MRI），10.5%（n=27）的终生 BC 风险为 15%或以上（考虑高危筛查）。符合遗传咨询/检测标准的患者有 257 例中的 61 例（23.7%）。总的来说，257 例患者中有 31.5%（n=81）符合高危/中危筛查、风险降低和/或遗传评估/检测标准，其中 92.8%的患者对进一步的信息和护理转诊感兴趣。
在作者所在的社区中，近三分之一接受乳房成像检查的患者符合 BC 高危评估和服务标准。大多数患者表示有兴趣接受此类服务。这些数据将用于财务规划和资源分配，以根据 NAPBC 指南在作者所在机构开发高危项目。他们希望这些努力将改善他们社区的 BC 肿瘤学结果和生存。
