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Breast cancer risk assessment

Evaluation of screening tools for genetics referral

Himes, Deborah O. PhD (Assistant Professor/Nurse Practitioner)1; Zaro, Maren L. MSN (Family Nurse Practitioner)1; Williams, Mary PhD (Professor)1; Freeborn, Donna PhD (Retired Professor/Nurse Practitioner)1; Eggett, Dennis L. PhD (Professor)2; Kinney, Anita Y. PhD (Professor)3

Journal of the American Association of Nurse Practitioners: October 2019 - Volume 31 - Issue 10 - p 562–572
doi: 10.1097/JXX.0000000000000272
Research: Quantitative
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Background and purpose: The United States Preventative Services Task Force (USPSTF) recommends breast cancer risk-screening tools to help primary care providers determine which unaffected patients to refer to genetic specialists. The USPSTF does not recommend one tool above others. The purpose of this study was to compare tool performance in identifying women at risk for breast cancer.

Methods: Pedigrees of 85 women aged 40–74 years with first-degree female relative with breast cancer were evaluated using five tools: Family History Screen-7 (FHS-7), Pedigree Assessment Tool, Manchester Scoring System, Referral Screening Tool, and Ontario Family History Assessment Tool (Ontario-FHAT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to describe each tool's ability to identify women with elevated risk as defined by Claus Model calculations (lifetime risk ≥15%). Receiver operating curves were plotted. Differences between areas under the curve were estimated and compared through logistic regression to assess for differences in tool performance.

Conclusions: Claus calculations identified 14 of 85 women with elevated risk. Two tools, Ontario-FHAT and FHS-7, identified all women with elevated risk (sensitivity 100%). The FHS-7 tool flagged all participants (specificity 0%). The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a NPV of 100%. Area under the curve values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools.

Implications for practice: The Ontario-FHAT outperformed other tools in sensitivity and NPV; however, low specificity and PPV must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to genetics specialists.

1College of Nursing, Brigham Young University, Provo, Utah

2Department of Statistics, Brigham Young University Provo, Utah

3School of Public Health, Rutgers, The State University of New Jersey, Camden, New Jersey

Correspondence: Deborah O. Himes, PhD, Brigham Young University, College of Nursing, 500 Spencer W. Kimball Tower, Provo, UT 84602. Tel: (801) 422-6066; Fax: (801) 422-0536; E-mail: Deborah-Himes@byu.edu

Competing interests: The authors report no conflicts of interest.

Authors' contributions: D. O. Himes: contribution to conception and design of work, acquisition of primary and secondary data, data analysis, data interpretation, drafting and revising writing. M. L. Zaro: contribution to conception and design of work, acquisition of secondary data, data analysis, data interpretation, drafting and revising writing. M. Williams: contribution to conception, design of the work, contribution to drafting, revising and critically appraising the work. D. Freeborn: contribution to conception, design of the work, contribution to drafting, revising and critically appraising the work. D. L. Eggett: contribution to conception, design of the work, data analysis, data interpretation, contribution to drafting, revising and critically appraising the work (statistical analysis and results). A. Y. Kinney: contribution to the acquisition and interpretation of data, revising the work and critically apprising for important intellectual content.

Received February 26, 2019

Received in revised form May 30, 2019

Accepted June 06, 2019

© 2019 American Association of Nurse Practitioners
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