定义高风险乳腺癌患者在安全网医院的服务需求：缩小差距的策略

Defining the Need for Services for Patients at High Risk of Breast Cancer at a Safety-Net Hospital: An Approach to Narrowing the Disparities Gap

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 Oct

作者: Olivia Cheng, Caroline Fiser, Jamie Paysour, Ruchi Aluwalia, Aysia Hilliard, Cletus Arciero, Clara R Farley, Jade Jones, Jesse Conyers, Lauren M Postlewait

DOI: 10.1245/s10434-024-15789-6

摘要

近期，国家乳腺癌认证项目（NAPBC）标准修订，旨在促进乳腺癌风险评估及高风险服务的转诊。本项目旨在估算在作者所在的安全网医院系统中高风险乳腺癌患者的比例，评估患者对高风险服务的兴趣，并明确项目开发所需资源。2023年两周内，接受乳腺影像检查的女性中，排除有乳腺癌病史或诊断的患者。采用Tyrer-Cuzick（TC）第8版模型计算乳腺癌风险。高/中等风险定义为10年风险≥5%、终生风险≥15%或两者兼而有之。依据NCCN指南，符合遗传咨询和检测的标准。共评估了257名患者，显示10年乳腺癌风险≥5%的有38例（14.8%，考虑内分泌治疗），终生风险≥20%的有16例（6.2%，符合年度MRI筛查资格），终生风险≥15%的有27例（10.5%，考虑高风险筛查）。符合遗传咨询/检测标准的有61例（23.7%）。总体上，有81例（31.5%）符合高/中等风险筛查、风险降低及/或遗传评估/检测的标准，其中92.8%的患者表示有兴趣接受相关转诊和进一步治疗。该地区近三分之一的乳腺影像检查患者符合乳腺癌高风险评估和服务条件。大多数患者对这些服务表现出兴趣。相关数据将用于财务规划和资源配置，以建立符合NAPBC指南的高风险项目。期待此举能改善肿瘤学结局和乳腺癌生存率。

Abstract

The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development.Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines.A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care.In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.