scholarly journals Genetic assessment wait time indicators in the High Risk Ontario Breast Screening Program

2018 ◽  
Vol 6 (2) ◽  
pp. 213-223 ◽  
Author(s):  
Andrea Eisen ◽  
Kristina M. Blackmore ◽  
Wendy S. Meschino ◽  
Derek Muradali ◽  
June C. Carroll ◽  
...  
Keyword(s):  
High Risk ◽  
Breast Screening ◽  
Screening Program ◽  
Wait Time ◽  
Genetic Assessment

Abnormal screens among nonmutation carriers in the High Risk Ontario Breast Screening Program

2021 ◽  
Author(s):  
Matthew Castelo ◽  
Zachary Brown ◽  
Angela E. Schellenberg ◽  
Jane K. Mills ◽  
Andrea Eisen ◽  
...  
Keyword(s):  
High Risk ◽  
Breast Screening ◽  
Screening Program

Implementation of a population-based breast screening program for high-risk women in Ontario: The Ontario Breast Screening Program (OBSP) High-Risk Program.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12034-e12034
Author(s):  
Andrea Eisen ◽  
June Carroll ◽  
Anna M. Chiarelli ◽  
Esti Heale ◽  
Meaghan Horgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Breast Screening ◽  
Screening Program ◽  
Primary Care Providers ◽  
Population Based ◽  
High Risk Women ◽  
Mutation Carriers ◽  
Organized Screening Program

e12034 Background: Genetic testing for mutations in BRCA1 and BRCA2 has been clinically available in Ontario since 2000. It is estimated that over 15000 individuals have been tested. Evidence from clinical trials have consistently shown that women at high risk of breast cancer such as BRCA1/2 mutation carriers benefit from breast cancer screening that includes both magnetic resonance imaging (MRI) of the breast and mammography, yet access to MRI in Ontario was variable. In 2011, Cancer Care Ontario established an expert panel to develop a protocol for expanding the Ontario Breast Screening Program, initially created for average risk women 50-74, to include MRI and mammography for eligible high risk women. Methods: The panel’s tasks included: 1. determining the criteria for high risk, 2. estimating the prevalence of high risk women, 3. selecting a model to estimate cancer risk, 4. developing a referral and assessment pathway for potentially eligible subjects to receive genetic counseling/risk assessment and screening if eligible, 5. developing educational resources, training plan and communication strategy for relevant stakeholders including primary care providers, oncologists, geneticists and genetic counselors, 6. developing indicators to permit program evaluation, 7. providing guidance for post-implementation issues such as subject eligibility and interpretation of genetic test results. Results: The program was initiated July, 2011 at 19 sites. Women aged 30-69 with and without a history of breast cancer are eligible if they 1. are BRCA1/2 mutation carriers or untested first degree relatives of carriers, 2. have a lifetime risk of breast cancer >=25% based on family history, or 3. received prior radiation therapy to the chest. It is estimated that 34000 high risk women in the target age group live in Ontario. Conclusions: A population based organized screening program for high risk women that includes genetic risk assessment has been implemented in Ontario. To our knowledge, this is the first organized screening program for women at high risk of breast cancer.

scholarly journals Performance Measures of Magnetic Resonance Imaging Plus Mammography in the High Risk Ontario Breast Screening Program

2019 ◽  
Vol 112 (2) ◽  
pp. 136-144 ◽  
Author(s):  
Anna M Chiarelli ◽  
Kristina M Blackmore ◽  
Derek Muradali ◽  
Susan J Done ◽  
Vicky Majpruz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Breast Screening ◽  
Screening Program ◽  
Breast Cancers ◽  
Resonance Imaging ◽  
High Risk Women ◽  
Mutation Carriers

Abstract Background The Ontario Breast Screening Program expanded in July 2011 to screen high-risk women age 30–69 years with annual magnetic resonance imaging (MRI) and digital mammography. This study examined the benefits of screening with mammography and MRI by age and risk criteria. Methods This prospective cohort study included 8782 women age 30–69 years referred to the High Risk Ontario Breast Screening Program from July 2011 to June 2015, with final results to December 2016. Cancer detection rates, sensitivity, and specificity of MRI and mammography combined were compared with each modality individually within risk groups stratified by age using generalized estimating equation models. Prognostic features of screen-detected breast cancers were compared by modality using Fisher exact test. All P values are two-sided. Results Among 20 053 screening episodes, there were 280 screen-detected breast cancers (cancer detection rate = 14.0 per 1000, 95% confidence interval [CI] = 12.4 to 15.7). The sensitivity of mammography was statistically significantly lower than that of MRI plus mammography (40.8%, 95% CI = 29.3% to 53.5% vs 96.0%, 95% CI = 92.2% to 98.0%, P < .001). In mutation carriers age 30–39 years, sensitivity of the combination was comparable with MRI alone (100.0% vs 96.8%, 95% CI = 79.2% to 100.0%, P = .99) but with statistically significantly decreased specificity (78.0%, 95% CI = 74.7% to 80.9% vs 86.2%, 95% CI = 83.5% to 88.5%, P < .001). In women age 50–69 years, combining MRI and mammography statistically significantly increased sensitivity compared with MRI alone (96.3%, 95% CI = 90.6% to 98.6% vs 90.9%, 95% CI = 83.6% to 95.1%, P = .02), with a small but statistically significant decrease in specificity (84.2%, 95% CI = 83.1% to 85.2% vs 90.0%, 95% CI = 89.2% to 90.9%, P < .001). Conclusions Screening high risk women age 30–39 years with annual MRI only may be sufficient for cancer detection and should be evaluated further, particularly for mutation carriers. Among women age 50–69 years, detection is most effective when mammography is included with annual MRI.

scholarly journals NF1 Patients Receiving Breast Cancer Screening: Insights from The Ontario High Risk Breast Screening Program

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 707 ◽  
Author(s):  
Nika Maani ◽  
Shelley Westergard ◽  
Joanna Yang ◽  
Anabel M. Scaranelo ◽  
Stephanie Telesca ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Breast Screening ◽  
Screening Program ◽  
Type I ◽  
Screening Programs ◽  
Increased Risk ◽  
High Risk Breast

Neurofibromatosis Type I (NF1) is caused by variants in neurofibromin (NF1). NF1 predisposes to a variety of benign and malignant tumor types, including breast cancer. Women with NF1 <50 years of age possess an up to five-fold increased risk of developing breast cancer compared with the general population. Impaired emotional functioning is reported as a comorbidity that may influence the participation of NF1 patients in regular clinical surveillance despite their increased risk of breast and other cancers. Despite emphasis on breast cancer surveillance in women with NF1, the uptake and feasibility of high-risk screening programs in this population remains unclear. A retrospective chart review between 2014–2018 of female NF1 patients seen at the Elizabeth Raab Neurofibromatosis Clinic (ERNC) in Ontario was conducted to examine the uptake of high-risk breast cancer screening, radiologic findings, and breast cancer characteristics. 61 women with pathogenic variants in NF1 enrolled in the high-risk Ontario breast screening program (HR-OBSP); 95% completed at least one high-risk breast screening modality, and four were diagnosed with invasive breast cancer. Our findings support the integration of a formal breast screening programs in clinical management of NF1 patients.

Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program

2014 ◽  
Vol 32 (21) ◽  
pp. 2224-2230 ◽  
Author(s):  
Anna M. Chiarelli ◽  
Maegan V. Prummel ◽  
Derek Muradali ◽  
Vicky Majpruz ◽  
Meaghan Horgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Gene Mutation ◽  
Breast Screening ◽  
Screening Program ◽  
Resonance Imaging ◽  
Mutation Carriers ◽  
Increased Risk

Purpose The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer. Patients and Methods Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously). Results The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%). Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Digital Compared with Screen-Film Mammography: Performance Measures in Concurrent Cohorts within an Organized Breast Screening Program

Radiology ◽  
2013 ◽  
Vol 268 (3) ◽  
pp. 684-693 ◽  
Author(s):  
Anna M. Chiarelli ◽  
Sarah A. Edwards ◽  
Maegan V. Prummel ◽  
Derek Muradali ◽  
Vicky Majpruz ◽  
...  
Keyword(s):  
Performance Measures ◽  
Breast Screening ◽  
Screening Program

Estimation of the benefit and harms of including clinical breast examination in an organized breast screening program

The Breast ◽  
2019 ◽  
Vol 43 ◽  
pp. 105-112
Author(s):  
Huan Jiang ◽  
Stephen D. Walter ◽  
Patrick Brown ◽  
Parminder Raina ◽  
Anna M. Chiarelli
Keyword(s):  
Breast Screening ◽  
Screening Program ◽  
Clinical Breast Examination ◽  
Breast Examination ◽  
Clinical Breast
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