Implementing an Individualized Breast Cancer Risk Assessment at the Coalville Health Center

Background: Breast cancer ranks as the second most common cancer among women, with incidence rates on the rise. Early detection through personalized risk assessment and adherence to screening guidelines improves the chances of detecting cancer in its early stages. Performing individualized breast cancer risk assessments can help patients understand when they should start annual screenings based on shared decision-making with their primary care provider. Local Problem: Women in rural communities often face disparities in accessing quality and regular screening. This rural clinic is in Northern Utah, an area with the second-highest incidence rate of breast cancer in the state. This clinic previously had no formal method for breast cancer screening. Methods: This quality improvement (QI) project first involved a retrospective chart review to establish a baseline for current breast cancer screening methods prior to the implementation of the evidence-based risk assessment. The evidence-based individualized risk assessment was adapted from the National Comprehensive Cancer Network guidelines and presented to the providers at the clinic during a process-based presentation. Pre-and post-presentation surveys were distributed to gauge provider knowledge and comfort regarding breast cancer screening and risk factors. Data were collected over six weeks to track the number of risk assessments conducted and missed opportunities. Eligibility criteria for the chart review and data collection included a female over the age of 18 that presented for an annual physical, annual wellness visit, or pap smear. Interventions: A baseline for the number of risk assessments performed was established during the retrospective chart review. The breast cancer risk assessment was implemented in the clinic following a workflow and educational presentation. Pre-and post-surveys were administered to the providers before and after the presentation. The findings of the project were discussed during a post-implementation provider discussion after the six weeks of data collection. Results: The pre-implementation baseline assessment found that of the 87 encounters that met the eligibility criteria, 26 (30%) should have received an individualized breast cancer risk assessment. However, as there was no documentation of this occurring in the EHR or elsewhere, all (100%) were classified as a missed opportunity. In comparison, data associated with the post- implementation found that of the 42 encounters during the implementation period that met the eligibility criteria, five (12%) were classified as missed opportunities. This represents an 88% reduction in missed opportunities. Post-intervention, all providers (n=3) reported increased confidence and competence in discussing breast cancer risk factors. Conclusions: The use of an individualized breast cancer risk assessment is a valuable tool for enhancing provider comfort and competence in identifying high-risk women and its usage reduces the proportion of missed opportunities and increases the proportion of completed cancer risk assessments.