Estimating lifetime risk for breast cancer as a screening tool for identifying those who would benefit from additional services among women utilizing mobile mammography.

Background: To estimate lifetime risk of breast cancer among women utilizing mobile mammography and to determine the proportion that might benefit from additional services, such as genetic counseling and educational programs.

Methods: Retrospective analysis of electronic health records for 2214 women screened for breast cancer on a mobile mammography van was conducted. Participants answered questions about their demographic characteristics, breast health, and family history of cancer. Logistic regression analyses were used to assess the odds of being recommended for additional services by the Tyrer-Cuzick (TC) lifetime risk score.

Results: The average TC ten-year risk score was 2.76 % ± 2.01 %, and the average TC lifetime risk score was 7.30 % ± 4.80 %. Using lifetime risk scores ≥ 10 %, it was determined that 444 patients (20.23 %) could be referred to additional services. Less than one percent of patients had been tested for the BRCA genes previously. The odds of being recommended for additional services by the TC model were significantly greater among those who were eligible for the New York Cancer Services Program (i.e., a proxy for lack of insurance) when compared to those who were ineligible (OR=1.31, 95 % CI: 1.03-1.66). After adjustment, screening borough and race/ethnicity were not significantly associated with being recommended for services.

Conclusion: Genetic counseling and education are some of the tools available to promote awareness and early detection of breast cancer; however, screening guidelines do not mandate genetic counseling or referrals for individuals at high-risk.

Policy Summary: Patients and providers should have discussions about predicted TC lifetime risk scores at follow-up breast cancer screening appointments, as this is a missed opportunity to improve care at both fixed sites and mobile clinics.