SLOs:

• Counsel patients on modifiable risk factors

• Develop tailored screening plans for patients from populations experiencing disproportionate disease burden due to social determinants of health and structural inequities.

• Demonstrate proficiency with risk assessment tools (Gail, Tyrer-Cuzick, etc.)

• Develop personalized risk reduction plans

• Identify appropriate candidates for SERMs and aromatase inhibitors

• Counsel patients on risk/benefit of prophylactic surgery

• Determine appropriate candidates for breast MRI and supplemental screening

• Create individualized screening plans for high-risk patients

• Refer appropriate patients for genetic counseling based on updated criteria

General Instructions:

In this activity, you will demonstrate your understanding of breast cancer risk assessment and risk reduction strategies through the development of personalized risk management plans and peer evaluation.

Step 1: Research and Preparation

•  First, review the slide sets on "Breast Cancer Risk Factors," "Risk Reduction Strategies," and "Screening in High-Risk Populations." These will provide you with foundational knowledge about risk assessment and management.

•  Then read the articles "Current Approaches to Breast Cancer Risk Assessment" and "Evidence-Based Risk Reduction Strategies."

•  Familiarize yourself with at least two breast cancer risk assessment tools (e.g., Gail Model, Tyrer-Cuzick, Breast Cancer Surveillance Consortium Risk Calculator).

•  Review the current NCCN guidelines for breast cancer risk reduction and screening for high-risk individuals.

Step 2: Case Analysis and Risk Management Plans

Develop risk assessment and management plans (800-1000 words total) for TWO of the following case scenarios:

Case 1: A 42-year-old African American woman with no personal history of breast cancer. Her mother was diagnosed with breast cancer at age 58, and she has one sister who is breast cancer-free. She began menstruating at age 11, had her first child at age 32, and has never used hormone replacement therapy. She has a BMI of 31 and drinks 5-7 alcoholic beverages per week. She has never had a breast biopsy.

Case 2: A 35-year-old Hispanic woman whose maternal grandmother and maternal aunt were diagnosed with breast cancer at ages 45 and 50, respectively. She has no personal history of contraceptives for 15 years. She has a BMI of 24 and exercises regularly. She had a breast biopsy at age 30 that showed atypical ductal hyperplasia.

Case 3: A 55-year-old Caucasian woman who tested positive for a BRCA1 mutation. She has no personal history of breast or ovarian cancer. Her mother and sister both had breast cancer in their 40s. She began menstruating at age 12, had two children before age 30, and went through menopause at age 52. She has a BMI of 27 and is currently taking medication for hypertension.

For each of your 2 selected cases, your management plan should include:

1. A quantitative risk assessment using at least two validated tools, with justification for tool selection, comparison of outputs, and discussion of limitations and uncertainty in calculated risk.
   

2. An analysis of modifiable and non-modifiable risk factors, including explanation of how you would counsel this patient about modifiable risk reduction strategies. Integrate relevant population-level data on breast cancer incidence and outcomes while critically examining how social determinants of health influence risk and care for patients from marginalized communities."
   

3. A personalized risk reduction plan that incorporates patient-specific lifestyle modifications, chemoprevention strategies, and consideration of prophylactic surgery when appropriate. For chemoprevention, determine candidacy for SERMs or aromatase inhibitors and justify your recommendation with specific criteria.
   

4. A tailored screening plan with justification for the recommended modalities and intervals, including the evidence-based criteria used to determine eligibility for breast MRI or other supplemental screening.

5. Genetic counseling and testing recommendations based on updated NCCN criteria, including an explanation of which criteria the patient meets and how these influence management decisions.
   

6. One patient-centered counseling point, such as discussion of risks and benefits of preventive strategies, addressing patient concerns, clarifying misconceptions, and incorporating patient preferences into shared decision-making.

Step 3: Share

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