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Biomarkers and Early Detection: Risk Markers and Surrogate Endpoints

Building blocks of Ville Marie's breast cancer risk assessment program.

Ville Marie Multidisciplinary Breast Centre, Montreal, PQ, Canada

Abstract

A14

Introduction : Most breast cancer cases are incidental and appear without any obvious risk factor. However, there is now sufficient data to identify a subgroup of higher risk patients who deserve even closer monitoring, and individualized management. To meet the needs of this group of patients, The Ville Marie Multidisciplinary Breast Centre has launched its Breast Cancer Risk Assessment Clinic (BCRAC) and program. Objectives : Our mission is to optimize the care of patients at high risk for breast cancer by providing information and opportunities to benefit from available chemoprevention strategies, genetic testing, and optimal imaging and individualized monitoring strategies, in addition to conventional imaging and detection tools. Methods : The first step in this process was to determine our target population. Next, to channel the patients that are at high risk for breast cancer and who will ultimately benefit most from risk assessment, we established a risk assessment algorithm. Patients who are referred by their physicians for risk assessment are sent a patient questionnaire. In addition to demographic patient information, this questionnaire addresses questions in the Gail model, BRCAPRO risk assessment, and the Manchester score. In addition, there must be an inbuilt mechanism to alert the patients regarding potential insurance, employment, and social discrimination if there is a strong family history of cancer, and/or genetic testing, particularly if it is determined that they have is a genetic basis for cancer. Thus, every attempt must be made to preserve patient confidentiality and privacy, as well as those of their family members. To ensure that all patients are informed of these issues, they appear in our clinic consent form, which must be signed by the patient before their first clinic visit. Finally, our research questions regarding patient demographics are subject to the same stringent evaluation and approval by our local institutional review board. Results : The questionnaire results are used to determine whether patients are eligible for NSABP chemoprevention based on the Gail model. In addition, the clinical and family history, imaging and pathology results, as well as risk assessment using the BCRAPRO software and the Manchester score are utilized to determine which patients should be evaluated for genetic testing, and which patients will benefit from individualized and optimized monitoring for high-risk patients. Conclusions : Breast cancer risk assessment is multifactorial, and dependent on a multidisciplinary team, including physicians, lawyers, ethicists, genetic counselors, nurses, coordinators, research personnel, and clerical staff. Equipped with optimized risk assessment tools and algorithms, this multidisciplinary team has the resources required to assess breast cancer risk, and then to optimize and individualize patient care, even for those at greatest breast cancer risk.