title: Short-term outcomes of the implementation of a computer-based breast cancer risk assessment program during screening mammography.
abstract: BACKGROUND
  Barriers to assessing a patient's risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient's risk for breast cancer at the time of having a mammogram.
  
  
  OBJECTIVE
  To facilitate identifcation of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment.
  
  
  METHODS
  Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient's risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation.
  
  
  RESULTS
  As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identifed as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients.
  
  
  CONCLUSIONS
  We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can beneft from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.
authors.affiliation: Leon Hess Cancer Center and Jacqueline M Wilentz Comprehensive Breast Center at Monmouth Medical Center, Long Branch, NJ USA Email: dmrzyglock@aol.com.
authors.forename: Debra
authors.initials: D
authors.lastname: Ray
authors.forename: Sherry
authors.initials: S
authors.lastname: Grumet
authors.forename: Portia
authors.initials: P
authors.lastname: Lagmay-Fuentes
authors.forename: Lolita
authors.initials: L
authors.lastname: Jacob
authors.forename: Annette
authors.initials: A
authors.lastname: Terzo
authors.forename: Alex
authors.initials: A
authors.lastname: Puma
authors.forename: Shirley
authors.initials: S
authors.lastname: Hwang