Navigation Helps At-Risk Patients Catch Breast Cancer Earlier

While national guidelines recommend that women at an increased risk of breast cancer undergo additional screening and get extra services, many individuals do not adhere to these recommendations simply because they are unaware of their risk.

In an attempt to remedy this problem, researchers from Stamford Hospital in Stamford, Connecticut employed a lay navigator to educate patients about the additional services. They recently presented their findings at the 37^th Annual Miami Breast Cancer Conference.

“We tracked patient acceptance of referral for risk reduction counseling, to medical oncology for consideration of chemoprevention, to genetic counseling when indicated as well as their willingness to participate in enhanced surveillance,” the authors wrote.

A total of 3,792 high-risk patients (as determined by the NCI Gail Model and version 8 of the Tyrer Cuzick Risk Assessment Model) were identified via mammography. To be determined high-risk, women had a 5-year risk greater than 1.67% and a lifetime risk of 20% or higher.

More than half (52%) who were not previously participating in the high-risk program were contacted by phone, and as a result, 398 (20%) made an appointment. At the time of the study’s end, 13 patients accepted referral to medical oncology, while 39 saw genetic counselors.

To-date, there were 14 patients who agreed to all genetic testing, and three of them had a deleterious mutation, such as BRCA, PALB2, NBN, that put them at higher risk for cancer. One patient who had a BRCA mutation even chose to have a bilateral prophylactic mastectomy.

Additionally, 133 patients were prescribed an MRI. At the time of presentation, 71 were completed, and 19 also needed an image-guided biopsy. Altogether, three cancers were diagnosed: two patients had ductal carcinoma in situ (DCIS) 1 patient was diagnosed with invasive lobular carcinoma.

“A lay navigator was effective in identifying high-risk patients and successfully guiding them to a comprehensive high-risk breast program,” the authors wrote. “As a result, these patients benefited from enhanced surveillance as indicated and risk appropriate consultations.”

Reference:

Burgwardt N, O’Riordan M, Baird C, et. al. Enhanced Navigation Improves Adherence to Recommended Guidelines by Woman at an Increased Risk of Breast Cancer. Presented at: 37^th Annual Miami Breast Cancer Conference. Miami, Florida. March 5-8, 2020.