A nurse-led initiative at the Vanderbilt Breast Center has set up a system so that women identified at high risk for breast cancer have greater opportunities for recommended follow-up screenings and genetic counseling.
Before the protocol, every patient underwent a Breast Cancer Risk Assessment Tool (BCRAT) evaluation, yet there was no established protocol for sharing the results. A team of six advanced practice providers devised a system using Epic software. Each week, they searched electronic health records of patients to identify who had BCRAT scores with a lifetime risk of breast cancer greater than 20%.
BCRAT scores are based on a woman’s medical and reproductive history as well as family history of breast cancer. The scores were sent through a secure electronic message to the patients’ referring physicians notifying them of the option for an additional referral to the Vanderbilt Breast Center high-risk clinic. Nurses also contacted patients directly and offered high-risk consultations.
Results of the intervention, which were published in the August issue of the Clinical Journal of Oncology Nursing, showed that the protocol resulted in increases in breast MRIs, genetic counseling and genetic testing.
“Most women are not aware of their own risk for breast cancer and options for screening,” said the study’s lead author Ashley Johnson, DNP, APRN. “Through use of a breast cancer risk assessment tool, patients and their providers can have a personalized discussion about breast health.”
During the first three months that the intervention protocol was implemented (October-December 2023), 150 of the 7,191 women who underwent mammograms were deemed at elevated risk for breast cancer. Of this number, 96 were already being seen in the high-risk clinic, one didn’t meet the study criteria, and nurses were unable to reach referring providers for seven.
A total of 46 were eligible for referral, and 33 were referred to the high-risk clinic. Thirteen providers did not refer their patients for follow-up screening and consultations at Vanderbilt. Of the 33 who did receive referrals, 14 patients declined the consultations. One of the 33 who did receive a referral was diagnosed with breast cancer during follow-up screenings.
“When informed of their risk for breast cancer, most referring health care providers and patients were motivated for personalized care,” Johnson said. “Most high-risk women seen in our breast center were interested in additional breast imaging and genetic services, and all reported high satisfaction with their advanced practice providers.”
Heather Jackson, PhD, APRN, is also an author of the study. Their work was supported by the Vanderbilt University School of Nursing Sigma Theta Tau Iota Chapter.
