title: Implementation and outcomes of a multidisciplinary high-risk breast cancer program: the William Beaumont Hospital experience.
abstract: Limited data are available on the implementation of a high-risk assessment program in the construct of a community clinical oncology program. The development of a high-risk breast cancer screening program at our institution identified 15%-20% of patients screened as high risk, with limited increases in structural or personnel requirements. Identification of patients as high risk could potentially improve outcomes by allowing for individualized prevention strategies and more appropriate high-risk surveillance.
  
  
  OBJECTIVE
  The implementation of a program that incorporates a risk assessment questionnaire (RAQ) to identify high-risk patients in a community-based health system was evaluated.
  
  
  METHODS
  Women with no history of breast cancer or ductal carcinoma in situ who were undergoing annual screening mammography were offered an RAQ. Cases determined to be high risk (Gail lifetime risk ≥20% or as indicated through personal and/or family history) were offered referral to our High-risk Breast Cancer Program. A retrospective data review was conducted on completed questionnaires.
  
  
  RESULTS
  A total of 5878 women underwent evaluation with the RAQ between September 2009 and August 2010. The mean age of the cohort was 55 years old, with 84.9% (4990) of participants being white, and 6.8% (400) African American. In the entire population, 45.7% (2446) had at least 1 first-degree relative with breast cancer (BC), and 923 (17.2%) women were found to be high risk by the Gail model. Beyond the Gail model, 53 (0.9%) women had undergone prior chest radiation, 34 (0.6%) had a male relative with BC, 200 (3.4%), had 3 or more relatives with BC on one side of their family, 308 (5.2%) had a relative with breast and ovarian cancer on one side of the family, and 105 (1.8%) noted 2 relatives with BC with onset under age 50 years on the same side of the family.
  
  
  CONCLUSIONS
  Our experience indicates that the identification of women at high risk for BC can be easily incorporated into an annual screening mammography visit. Identification of these patients as high risk can allow for individualized, more-appropriate surveillance and prevention.
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University, William Beaumont Hospital School of Medicine, Royal Oak, MI 48073, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.forename: Sameer
authors.initials: S
authors.lastname: Berry
authors.forename: Nayana
authors.initials: N
authors.lastname: Dekhne
authors.forename: Thomas
authors.initials: T
authors.lastname: Lanni
authors.forename: Heather
authors.initials: H
authors.lastname: Lowry
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006284:Health Plan Implementation; D006761:Hospitals; D006801:Humans; D033183:Interdisciplinary Communication; D008824:Michigan; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome