Implementation of a High-Risk Breast Clinic for Comprehensive Care of Women With Elevated Breast Cancer Risk Identified by Risk Assessment Models in the Community

INTRODUCTION: Many radiology centers perform risk assessment at time of screening mammography. The Massachusetts General Hospital North Shore Cancer Center (MGHNS) developed a nurse practitioner (NP)–led high-risk breast clinic (HRBC) to provide comprehensive care for patients with elevated cancer by validated tool. PATIENTS AND METHODS: Patient and administrative data from the MGHNS HRBC was collected evaluate clinical implementation outcomes. We compared those identified as having ≥ 20% lifetime 5 community imaging centers. RESULTS: From March 2018 February 2019, 318 were seen in HRBC; 264 (83%) had risk, 13 (4%) prior atypia/lobular carcinoma situ, 9 (3%) 1.7% 5-year 32 (10%) no indication risk. Genetic testing recommended 159 (50%); 33 (21%) completed 1 mutation identified. Chemoprevention discussed 99 (31%); (9%) initiated treatment. Screening magnetic resonance (MRI) 284 (89%); 184 (65%) MRI performed 2 mammographically occult cancers During this period, 215,112 imaging; these, 1,170 found have Compared high community, more likely be white (94.3% v 85.4%; P < .001) family history ovarian (16.4% 9.4%; .001). CONCLUSION: demonstrate feasibility an NP-led HRBC. Follow-through recommendations highest MRI; use genetic chemoprevention lower than anticipated. In our uptake referring providers remains barrier, only minority assessed clinic.