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High Risk Ontario Breast Screening Program FAQs for Healthcare Providers

Healthcare providers are the first point of contact for women who may be eligible for breast screening through the High Risk Ontario Breast Screening Program (High Risk OBSP). The following information answers many of the questions healthcare providers commonly ask.

What are the roles and responsibilities of healthcare providers in screening women at high risk for breast cancer?

Physicians are responsible for completing the OBSP Requisition for High Risk Screening and for submitting this form to the designated High Risk Ontario Breast Screening Program (High Risk OBSP) site. This requisition serves as a referral for consideration of eligibility for the High Risk OBSP. Women who meet all eligibility criteria in Category A do not require genetic assessment, while women referred under Category B will require genetic assessment and possibly genetic testing to determine their eligibility for the High Risk OBSP:

  • Category A – Eligible for direct entry into the High Risk OBSP based on personal and family history. Must meet one of the following risk criteria:
    • Known to have a gene mutation that increases their risk for breast cancer (e.g., BRCA1, BRCA2, TP53, PTEN, CDH1)
    • First-degree relatives of someone who has a gene mutation that increases their risk for breast cancer (e.g., BRCA1, BRCA2, TP53, PTEN, CDH1), have already had genetic counselling and have chosen not to have genetic testing
    • Have been assessed by a genetics clinic (using the IBIS or BOADICEA tools) as having a 25% or greater lifetime risk of breast cancer based on personal and family history
    • Have had radiation therapy to the chest to treat another cancer or condition (e.g., Hodgkin lymphoma) before age 30 and at least 8 years ago
  • Category B – Genetic assessment required to determine eligibility for High Risk OBSP. Must meet one of the following risk criteria:
    • First-degree relative (parent, brother, sister or child) of a carrier of a gene mutation (e.g. BRCA1, BRCA2, TP53, PTEN, CDH1) and has not had genetic counselling or genetic testing
    • Personal or family history of breast or ovarian cancer suggestive of a hereditary breast cancer syndrome

If a woman progresses through genetic assessment and is not found to be at high risk for breast cancer, it is the responsibility of her healthcare provider to discuss risk-appropriate screening. If a woman is deemed to be eligible for high risk screening, her healthcare provider will receive imaging results from her screening tests directly from the High Risk OBSP site.

Can a nurse practitioner authorize the OBSP Requisition for High Risk Screening?

While nurse practitioners can complete the requisition, they cannot approve it according to current regulations. A physician with a College of Physicians and Surgeons of Ontario (CPSO) number needs to sign off on the requisition because it is an implied requisition for future magnetic resonance imaging (MRI) and image-guided biopsies as appropriate.

How can the High Risk OBSP navigator support women?

The High Risk OBSP navigator helps guide women through their eligibility process for high risk screening:

  • The High Risk OBSP navigator connects women referred to the program with genetics clinics for genetic assessment, if appropriate.
  • If a woman is found to be eligible for the program, the navigator will book appointments for screening breast magnetic resonance imaging (MRI) (or screening breast ultrasound if MRI is not medically appropriate). The navigator helps guide women with abnormal screening results through to diagnosis by coordinating follow-up tests and documenting the results of those tests.

Am I responsible for completing the genetic assessment?

No. The genetics clinic provides all genetic and risk assessment services to women to determine their eligibility for high risk screening. However, you can help facilitate an accurate breast cancer risk assessment by providing as much family history information as possible on the referral.

What is the value of genetic assessment and what is the process my patient goes through to determine her eligibility for high risk screening?

When a woman visits the genetics clinic, she meets with a genetic counsellor to review her family and medical history, and discuss any implications to her health. Genetics clinics use the IBIS and BOADICEA breast cancer risk assessment tools to assess all women who may be at high risk for breast cancer. These tools assess the probability of carrying a deleterious genetic mutation (e.g., BRCA1, BRCA2, TP53, PTEN, CDH1) and of developing breast cancer. Several models exist to assess the risk of developing breast cancer; however, the IBIS and BOADICEA have been chosen as the standard assessment tools for eligibility for screening through the High Risk Ontario Breast Screening Program (High Risk OBSP).

Genetic testing may not be required for eligibility into the program but genetic assessment for women with a family history suggestive of hereditary breast cancer is strongly encouraged.

If a woman is eligible for genetic testing, she will be offered the test. For the test, her blood is drawn and sent to a lab for processing. Once the lab results come back, the woman returns to the genetics clinic to discuss her results and her risk mitigation options, if appropriate.

Genetic testing alone is not required to determine if a woman is eligible for the High Risk OBSP.

What if my patient does not want to go through a genetic assessment?

The staff at the genetics clinic are specially trained to assess and counsel women who may be at high risk for breast cancer. They are keenly aware of the sensitive nature of this consultation and are able to support women through the assessment process. Women who choose not to undergo assessment and do not meet the criteria for Category A will not be deemed eligible for the program. Download and refer to the OBSP Requisition for High Risk Screening for Category A criteria.

How will I be kept informed of my patient’s results?

Genetics clinics are responsible for communicating genetic results to women and for sending these results to the referring physician. Please note that wait times for genetic assessment vary across the province; it may take up to several months for a woman to receive the results of her genetic testing.

The High Risk OBSP site is responsible for communicating all imaging results to women and for sending these results to the referring physician.

Why should women at high risk for breast cancer receive screening magnetic resonance imaging (MRI)?

Women at high risk have a greater estimated lifetime risk of developing breast cancer (up to 85%) than the general population (10% to 12%). For women at high risk, screening with mammography alone has limitations:

  • Younger women have greater breast density than older women.
  • Mammography is less sensitive for women with deleterious genetic mutations (e.g., BRCA1, BRCA2, TP53, PTEN, CDH1) due to the faster growth of cancer among these women.

MRI technology addresses some of the screening limitations of mammography for women at high risk. When used in combination, mammography and MRI find more cancers in women at high risk for breast cancer than using mammography or MRI alone.

How are potentially high risk women identified if they are currently in the OBSP being screened by mammography?

Women who are currently being screened through the Ontario Breast Screening Program (OBSP) may self-identify as being potentially at high risk for breast cancer. OBSP site staff should encourage these women to make an appointment with their healthcare provider. Their healthcare provider will review the OBSP Requisition for High Risk Screening form to determine if they meet the referral criteria for the High Risk OBSP under Category B.

If a woman already has a mammogram booked with the OBSP and is referred to the High Risk OBSP, she should proceed with screening while her genetic assessment is being completed.

What are the screening guidelines for women at high risk who have breast implants or who have previously had breast cancer?

Women who have breast implants (without bilateral mastectomies) or who have previously had breast cancer may be referred for an assessment of eligibility for screening through the High Risk Ontario Breast Screening Program.

 

How will my patient’s personal health information be used and disclosed?

All personal health information collected through the Ontario Breast Screening Program (OBSP) will be used to inform planning for breast screening, and to provide screening results to patients and healthcare providers. Some of this information may also be used to conduct analysis and compile statistics on breast cancer screening and assessment, which will assist in informing future program design.

The OBSP continues to monitor new evidence and review results of its program evaluation to improve the quality, effectiveness and delivery of its breast cancer screening and assessment services.

We have strict privacy practices in place which must be approved by the Information and Privacy Commissioner of Ontario every 3 years.