Download Establishing a High Risk Breast Cancer Clinic: The Kaiser

Establishing a High Risk Breast Cancer Clinic:
The Kaiser Permanente Los Angeles Medical
Center experience
Presenter: Jennifer H. Lin MD1,2
Co-Authors: Anna Leung MD1,2, Stephanie Morton MS, LCGC3
Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
2 Alumni Fellow, John Wayne Cancer Institute, Santa Monica, California, USA
3 Department of Genetics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
1
Abstract identifier: RF4-2
Submission type: Practice, policy and advocacy reports
Track 1- Stemming the tide: innovations in prevention and screening
Abstract presented before: no
Disclosure of interest: none
Establishing a High Risk Breast Cancer Clinic:
The Kaiser Permanente Los Angeles Medical Center experience
BACKGROUND
• 5-10% of breast cancers are associated with an inherited susceptibility
• Approximately 25% of hereditary cases can be attributed to BRCA mutations
• Comprehensive panel testing has become increasingly utilized, and detection of
other genes associated with hereditary (non-breast/ovarian) cancers has risen
• Detection of these mutations poses a unique challenge in coordination of
screening
• Some genes are uncommon cancer predisposition genes that do not have
established screening guidelines
Establishing a High Risk Breast Cancer Clinic
AIM
• To provide a coordinated approach to care once a patient has been identified as
having a hereditary risk
• To help improve adherence to early detection programs, provide prophylactic
options, and ensure continuity of care for the patient and other at-risk family
members
PROGRAM
• The High Risk Breast Cancer Clinic (HRBC) at KP LAMC was established in 2011
• A multidisciplinary approach in one clinic visit with a core group of specialists:
– Surgical Oncology, Gynecology Oncology, Medical Oncology, Genetics, Internal Medicine,
Plastic Surgery, Radiology, and Social Medicine
Establishing a High Risk Breast Cancer Clinic
STRATEGY
1) A multi-disciplinary case conference
2) New Patient Clinic
– Individual consultations with each specialist regarding screening, chemoprevention, or
prophylactic surgery
– Other specialists are consulted as needed: Gastroenterology, Colorectal Surgery
3) Follow-up Patient Clinic
– Seen annually with a HRBC Internist to ensure all screening tests (imaging, labs) and
physical examinations are completed
All patients are offered access to our Social Worker, support groups, weight
management programs, cancer nutritionists
Establishing a High Risk Breast Cancer Clinic
Outcomes
• 430 patients had gene panel testing
– 29 BRCA mutations
– 21 mutations in other genes (APC, ATM, CHEK2, MSH6, MUTYH, PALB2, PMS2, SMAD4,
TP53)
– 162 variants of unknown significance (VUS)
• To date the clinic has seen 124 new patients and 90 follow-up patients
– These include patients with pathogenic mutations, VUS, or a strong family history but
negative test results
• Patient surveys indicate a high level of satisfaction and compliance
Conclusion: Our HRBC serves as a model of care-coordination in cancer prevention
and developing expertise through multi-disciplinary collaborations