Abstract
Breast cancer screening has historically utilized a population-based approach. However, recent literature and evidence supports improvements in breast cancer screening through the utilization of risk-based tools to guide shared decision-making. The purpose of this project was to improve shared decision-making for breast cancer screening that utilized a risk-based screening process, with specific focus on breast density. The project used the Tyrer-Cuzick tool for risk-based screening among female participants aged 40-74 with no prior history of breast cancer who were presenting for their annual exam. This quality improvement project utilized a pre- and post-test survey to identify changes in perceptions toward risk-based screening and shared decision-making. Chart reviews were conducted following 12-weeks of data collection to evaluate results including breast density, lifetime risk for breast cancer, and the percentage of the participants who received screening in addition to the baseline mammogram. Of the 53 patients that were surveyed, 34% had dense breast tissue. Twenty-three percent of those surveyed had a Tyrer-Cuzick risk score greater than 15%. Of these 23%, (four patients) had lifetime risk of breast cancer greater than 20% and were recommended to have supplemental screening. Of the six providers that were educated and originally elected to participate, two completed patient questionnaires and returned the post-test. Both of these providers identified that the Tyrer-Cuzick tool was helpful in improving shared decision-making with a more objective approach; however, time constraints were identified as the biggest barrier to future use. In conclusion, a risk-based tool for breast cancer screening, such as the Tyrer Cuzick, has potential to improve shared decision-making in primary care visits. However, further studies could examine how to make this a more efficient practice.|Keywords: breast cancer screening, Tyrer-Cuzick tool, shared decision-making, breast density