Implementation of a Risk Assessment Process in a Primary Clinic to Identify Women at High Risk for Developing Breast Cancer Based on Family History

Breast cancer is the second leading cause of cancer death and the leading cause of premature death of women in the United States (US). It was estimated that 231,840 women were expected to develop breast cancer in the US in 2015 and approximately 40,290 women were estimated to die of the disease. Even though most breast cancers are sporadic, 5-10% of women are at an increased risk for developing breast cancer due to a hereditary risk. Too few healthcare providers are identifying women with family histories suggestive of hereditary cancer syndromes. An efficient way to identify high risk women in the primary care setting is through an easy to understand, self-administered family history risk assessment tool. The Pedigree Assessment Tool (PAT) family history questionnaire was offered to women age 18 and over at a primary care clinic in northern Louisiana. A PAT score of 8 or above prompted a cancer family history discussion by the physician or nurse practitioner and was followed by a genetic counseling referral. A total of 428 women completed the risk assessment tool during a 4 month period, 32 were high risk as evidenced by scoring 8 or higher on the PAT. Fourteen women were referred for genetic counseling. Twelve declined testing due to lack of insurance coverage, previous completion of genetic testing or felt the information would not improve their health. Six of the thirteen women completed genetic counseling and genetic testing. Lack of insurance coverage was identified as a major barrier to genetic counseling referrals. Utilization of the PAT identifies high risk women who would benefit from a genetic counseling referral. Genetic testing provides information that allows the patient and primary care provider to make informed decisions regarding surveillance protocols or prophylactic surgeries to diagnose cancer at an early stage or prevent cancer from developing