High Risk Ontario Breast Screening Program FAQs for Genetics Clinics

For all Category B referrals through a High Risk Ontario Breast Screening Program (High Risk OBSP) site, the High Risk OBSP navigator will provide a copy of the OBSP Requisition for High Risk Screening form to the genetics clinic. Once the genetic assessment is complete, if the woman authorizes the release of her results, the genetics clinic must return the requisition back to the High Risk OBSP site along with the following completed forms:

• Genetics Report Form

For all referrals received directly from a physician, the genetics clinic is required to:

• complete the OBSP Requisition for High Risk Screening (if the referring physician did not complete it)
• complete the Genetics Report Form
• have the woman sign the Authorization for the Release of Personal Health Information for Genetic Assessment

The completed documentation should then be sent to a High Risk OBSP site. Genetics clinics are responsible for communicating genetics results to women and for sending these results to the referring physician, following current practice.

No. The genetics clinic is only responsible for providing genetic assessment services and communicating the results. The genetics clinic will send the results of the genetic assessment to the woman who was tested, the referring physician and the Ontario Breast Screening Program (OBSP) for all breast and ovarian assessment cases.

If a woman progresses through genetic assessment and is not found to be at high risk for breast cancer, it is the responsibility of the referring physician to review the woman’s results with her and discuss risk appropriate screening.

If a woman is eligible for high risk screening, the healthcare provider identified on the Genetics Report Form will be sent her screening results directly from the diagnostic imaging department. If a woman’s results are normal, she will receive her results directly from the OBSP. The High Risk OBSP site will make sure follow-up is completed for any abnormal screens, either directly with the woman or with her referring physician.

The most common genes associated with hereditary breast cancer risk are BRCA1 and BRCA2. Other high risk genes include TP53, PTEN, and CDH1. The decision to test for alterations in these other genes will depend on several factors, including cancer history characteristics. The genetics clinic and genetic experts will make recommendations based on the test results.

The CPSO registration number is a unique 5- digit number assigned to each physician in Ontario. If the referral came through the Ontario Breast Screening Program (OBSP), the CPSO registration number can be found at the bottom of the OBSP Requisition for High Risk Screening form that is faxed to the genetics clinic. If the number is not listed there, or if a requisition was not sent to the clinic, look for the CPSO registration number on the CPSO website by entering the physician’s first name, last name, gender and language of service.

Upon completion of the genetic assessment for all breast and ovarian cases, the genetics clinic must provide the OBSP with the Genetics Report Form, the OBSP Requisition for High Risk Screening and the Authorization for the Release of Personal Health Information.

In 2018, breast cancer was expected to be the most common cancer diagnosed in Ontario women. By collecting data from breast and ovarian cancer genetic assessments, the OBSP is able to better develop best practices for early detection of breast cancer. The information collected through these assessments informs program design, permits the OBSP sites to identify women as high risk in the OBSP’s database and makes sure that Ontario responds appropriately to issues related to capacity.

No. Assessment of a woman’s personal risk of developing breast cancer to determine her eligibility for the High Risk Ontario Breast Screening Program (High Risk OBSP) must be determined using the IBIS or BOADICEA tools. The IBIS and BOADICEA risk assessment tools are not based on the Gail model. The Gail model is a validated risk-assessment model that focuses primarily on non-hereditary risk factors, with limited information on family history. All studies of magnetic resonance imaging (MRI) breast screening to date have focused on women at increased risk due to family history or genetic status.

The decision to screen in the High Risk OBSP should be made in conjunction with clinical judgement. Some women who are eligible may not benefit from screening to detect early disease, such as women with advanced ovarian cancer or metastatic breast cancer.

The IBIS and BOADICEA breast risk assessment tools have been chosen as the standard assessment tools to determine eligibility for the High Risk Ontario Breast Screening Program.

Find further information about the IBIS and BOADICEA risk assessment tools in these articles:

• IBIS (also known as the Tyrer-Cuzick model): Tyrer J, Duffy SW, Cuzick J (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23.
• BOADICEA: Antoniou AC, Cunningham AP (2008) The BOADICEA model of genetic susceptibility to breast and ovarian cancers: updates and extensions. British Journal of Cancer.

Annual breast MRI (or, if MRI is not medically appropriate, screening breast ultrasound) and mammography are the recommended standard of care for women at high risk because they complement each other:

• A limitation of mammography is that it does not perform well in women with high mammographic breast density.
• Younger women have greater breast density than older women.
• Mammography appears to be less sensitive for women with a genetic predisposition to breast cancer due to the faster growth of breast cancers in these women.
• Breast cancers in women at high risk may exhibit features that appear benign on mammography.
• Unlike mammography, MRI is not affected by breast density.
• When used in combination, mammography and MRI find more cancers than using MRI alone in women at high risk.