Risk Reduction in a Breast Center:

The Clinical Breast Care Project Experience

Authors:  Craig D. Shriver MD FACS; Silvia Johnson RN; Darrius Mydlarz MD; Zia Dehquanzada MD

Location Address:  Comprehensive Breast Center, Walter Reed Army Medical Center, Bldg.2, Ward 55, Washington, DC 20307-5001

Designated Authors:  Craig D. Shriver MD FACS; craig.shriver@na.amedd.army.mil

Introduction:  Breast cancer Risk Reduction is standard of care for patients identified as above-average risk based on computerized risk assessment models. Establishing this capability for screening, identifying, and following these patients is a new development for Breast Centers to deal with.

Methods:  We began our CBCP Risk Reduction program in November 2000. Screening for patients takes place in primary care and specialty clinics. Patients with risks above threshold are referred to the Risk Reduction Clinic in the Breast Center. Patients are individually assessed and counseled by the team of a specialty RN and a physician Medical Oncologist, spending over an hour with each individual patient. Patients are enrolled in IRB-approved protocols for database analysis and prospective follow-up. SOPs are in place for treatment and follow-up of all patients on chemoprevention. We proactively and aggressively treat to prevent common side effects of chemoprevention.

Results:  Over 200 patients have been identified as high-risk and seen in the Risk Reduction Program. Receptivity rate of eligible patients accepting chemoprevention after being seen are 60%, compared to other high-risk program reports of 10% (MSKCC) and 20% (STAR Trial). SOPs have been successful in minimizing the side effects of chemoprevention.

Conclusions:  Risk Reduction clinics can be established successfully in Breast Centers. Using a model of one-on-one patient-Nurse-Physician interaction results in higher rates of acceptance of chemoprevention in high-risk patients than reported in other care models. Pre-empting side effects of chemoprevention results in greater patient satisfaction and acceptance of long-term therapy.