title: Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer.
abstract: We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST).
  
  
  
  RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk.
  
  
  
  The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST.
  
  
  
  The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.
authors: University of California, Davis Division of Biostatistics, Sacramento, CA, USA.
authors: Susan L
authors: SL
authors: Stewart
authors: Celia P
authors: CP
authors: Kaplan
authors: Robin
authors: R
authors: Lee
authors: Galen
authors: G
authors: Joseph
authors: Leah
authors: L
authors: Karliner
authors: Jennifer
authors: J
authors: Livaudais-Toman
authors: Rena J
authors: RJ
authors: Pasick
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D005817:Genetic Counseling / Q000458:organization & administration; D020022:Genetic Predisposition to Disease; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011203:Poverty; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity