Breast Cancer Risk Assessment Will Now Be Available On Premier Screening Mammogram Reports
By Diane Anderson, DO, medical director, North Breast Centers; and M. Patricia Braeuning, MD, medical director, South Breast Centers
A long- awaited breast cancer risk assessment tool is now available!
Tyrer-Cuzick version 8 Breast Cancer Risk Assessment will now be available to Premier Health patients when they present for their screening mammograms.
Patients will be asked a series of questions by the technologist when they present for mammography on the following topics:
- Current age
- Age at menarche
- Height
- Weight
- Parity
- Age at first childbirth
- Age at menopause
- HRT use
- Prior benign biopsy results (especially atypia)
- Ovarian cancer
- Ashkenazi descent
- Age at diagnosis of first- and second-degree relatives with breast and/or ovarian cancer and male relatives with breast cancer
This version of TC also includes mammographic breast density, which will be added to the calculation by the radiologist.
As the quality of the assessment depends on the accuracy of the patient provided information, you may wish to encourage your patient to know the answers to these questions prior to arriving for her screening appointment.
The risk assessment will be reported in the body of the screening report on normal screening studies.
At this point, we are hesitant to include the TC risk score in reports of those patients read as Category 0, as we do not wish to confuse the need for additional evaluation based on the mammo finding. This may be subject to change as we gather more experience and input from our primary care providers. Please share your thoughts.
Patients with the highest risk of developing breast cancer (>20% lifetime risk) should be undergoing yearly mammography and be offered additional screening with breast MR. If your patient is unable to undergo breast MR, consider adding screening ultrasound. For these high-risk patients who tend to develop more aggressive cancers, the recommendation is that the mammogram and MR be performed yearly, staggered at 6 month intervals.
Important Points
Most women who develop breast cancer do not have a family history or identifiable risk factors. Therefore, a low score does NOT preclude the need for annual mammographic screening.
A high TC score suggests that additional screening is indicated in addition to mammography.
A low score does NOT change the recommendation for annual mammography and CBE.
We welcome your input regarding implementation of this new service. Please contact us at dhanderson@premierhealth.com or mpbraeunin@premierhealth.com
Helpful Information
Tyrer-Cuzick scores:
Average risk -14,9% or less lifetime risk
Moderate risk -15-19.9% lifetime risk
High risk-20% or greater lifetime risk
Supplemental screening options (in addition to mammography with tomosynthesis):
Screening Breast US is a complete bilateral breast US. This is useful in patients with dense breasts who cannot undergo MR.
Breast MRI requires IV contrast administration. The full protocol is about a 60 minute exam. This offers the best characterization of lesions. Most insurance companies require pre-approval.
Fast Breast MRI is an abbreviated exam about 10 minutes in length. It still requires IV contrast. Some of the sequences are omitted to decrease scan time and therefore exam cost. This may miss some subtle lesions but has proven to be a good screening exam. This is a pay out of pocket exam ($400) which is often less than the patient’s co-pay for a full protocol exam. This still requires a prescription.
Back to the March 2023 issue of Premier Pulse
