Lifetime Breast Cancer Risk Assessment

Lifetime Breast Cancer Risk Assessment

Overview

The LMH Health Women’s Center works in conjunction with the LMH Health Cancer Center to deliver this enhanced program to identify breast cancer risk. The estimated lifetime risk of breast cancer will be calculated on all patients referred for mammography.

  • Mammography services are provided at our LMH Health Women’s Center located on the LMH Health West campus.
  • A mammography technologist, specializing in patient-centered care, will assist the patient with completion of the Lifetime Breast Cancer Risk Assessment form (also known as the Tyrer-Cusick form).
  • Post mammogram, the patient’s images will be reviewed by a board-certified, sub-specialty trained radiologist.
  • If a patient’s form indicates a 20 percent or greater lifetime risk for developing breast cancer, the patient will be referred to Lawrence Breast Specialists for evaluation. This clinic is housed within the LMH Health Women’s Center, located on the LMH Health West campus. If the clinicians of Lawrence Breast Specialists feel additional consultative services are needed, the patient will be referred to the LMH Health Cancer Center for genetic testing or additional care needs.

Tyrer-Cuzick Risk Assessment model

The Tyrer-Cuzick risk assessment model is used to calculate the estimated score for lifetime risk of breast cancer. This value will be reported in the mammogram report to the referring physician and patient. Most facilities consider 20% or greater lifetime risk as the cut off for high-risk evaluation and referral to a high-risk breast health clinic. LMH Health has adopted this guidance.

What is the scoring mechanism for Tyrer-Cuzick?

Tyrer-Cuzick Assessed Risk Factors

  • Age
  • Height
  • Weight
  • Age at menarche
  • Number of live births
  • Age at first delivery
  • Age at menopause/status of menopause
  • Breast density
  • Ashkenazi Jewish heritage
  • History of hormone use
  • Genetic testing results for BRCA 1 and BRCA 2
  • Full family history
  • Atypical breast biopsies, ie: ADH, ALH, LCIS
  • History of breast biopsy/surgery
  • Personal or family history of breast cancer
  • Personal or family history of ovarian cancer
  • Age cancer was diagnosed
  • Cancer in one breast or both breasts
  • Competing mortality

Patient Experience

  1. A mammography technologist, specializing in patient-centered care, will assist the patient with the completion of the Lifetime Breast Cancer Risk Assessment form at their Mammogram appointment.
  2. The LMH Health Women’s Center will be using the Tyrer-Cuzick Risk Assessment Model which generates an estimated % lifetime risk. This value will be reported in the mammogram report and also provided to the patient in their results letter.
  3. If the patient has a score of under 20% and the mammogram is normal, the referring physician will be communicating that to the patient and recommending a 1-year follow-up mammogram. Patients will also be notified of this information in their results letter.
  4. If the patient has a 20% or greater lifetime high-risk score, it is recommended the patient be referred to Lawrence Breast Specialists.
  5. If the patient and the referring providers are interested in high-risk consultation, the referring provider should contact Lawrence Breast Specialists to set up the referral. Patients will also be notified through the results letter of their score and to contact their referring provider to make a referral to the clinic.
  6. Once the referral is made from a PCP, LMH Health Women’s Center/Lawrence Breast Specialists can contact the patient to schedule the appointment.
  7. At the appointment, Dr. Jennifer Hawasli (Lawrence Breast Specialists) will go over the score and discuss options. There are many options for higher risk patients including, more aggressive screening protocols, and chemoprevention and in some cases prophylactic surgery. Examples of more aggressive screening protocols would include alternating mammography and screening MRI, or in some cases genetic counseling for possible genetic mutation testing.
  8. Dr. Hawasli can refer to the LMH Health Cancer Center (Dr. Jodie Barr/Dr. Sharon Soule) as needed for genetic testing if applicable.

Expected turnaround time for results

The results will be included in the Mammography report. The expected turnaround time should not change. Currently, screening mammograms are read the same day just a few hours later, or the following morning. So the turnaround time for mammography results to physicians is typically 24 hours.

Report Delivery

  • LMH Health Providers will receive notification through a message in Cerner to check the patient’s results. The report will contain the Tyrer-Cuzick score.
  • Independent Referring Providers will be faxed a report.

Referrals to Lawrence Breast Specialists

  • LMH Health Providers: Send the referral through Cerner
  • Independent Providers: Lawrence Breast Specialists Phone: 785-505-3715 or Fax: 785-505-5248

Physician or Staff Questions:

For questions about the process, call the LMH Health Mammography Supervisor at 785-505-3722.

Patient Questions:

If a patient has questions about the process, have them call The LMH Health Women’s Center at 785-505-3800.

Patient information on the Tyrer-Cuzick Risk Assessment

Information is available on breastcancer.org | Go to link

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