Maron D

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Purpose: To demonstrate Lean Process Improvement methodologies in a multidisciplinary, multicenter model to screen for increased risk of breast cancer in Women Veterans. We strive to deliver a team-based, cross-functional model that meets the unique healthcare needs of female Veterans and results in a Veteran-centric delivery of care.

Relevant Background/ Problem: Women are the fastest growing veterans population seeking care at the VA Health Administration (VHA). There is also an increased risk of breast cancer in Women Veterans. Based on national guidelines we are developing tools to promote the use of screening for high risk breast cancer and its prevention as well as other breast health issues.

Methods: A 9 institution, multidisciplinary team including oncology, surgery, nursing, pharmacy, biostatistics, genetic counseling, mental health, and health systems engineering was launched at the 2014 AVAHO annual meeting. Since then, the group has met every 2 weeks by conference call and has developed subcommittees focusing on International Review Board approval, data collection, grant writing, survey design, and strategic planning. We have developed tools to collect data, CPRS research notes, and a multiple choice questionnaire.

Results: As a result of combined efforts, currently 5 studies are being conducted: Know your breast cancer risk factors and prevention options-pilot program currently enrolling patients at 2 sites. The preliminary data will be presented at AVAHO. Chemoprevention in VHA system: A VINCI data review from 2000-2015 VINCI data review of prophylactic mastectomies at VHA from 2000-2015. Survey for Primary Care physicians regarding awareness of increased risk breast cancer screening and prevention options. Lean Process Improvement project to roll out a program to increase the use of CVT so that VAMCs may offer screening and primary prevention for high risk breast cancer. Additionally, we are offering genetic counseling and plan to improve adherence to chemoprevention through the use of CVT.

Implications/Future Directions: Lean Process Improvement may be an effective method to coordinate clinical care in high risk breast cancer screening and awareness. This process should be considered as a model throughout the VHA system to offer care in accordance with national guidelines for our Women Veterans.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Purpose: To increase the appropriate breast cancer risk quantification, utilization of chemoprevention, and genetic counseling among Women Veterans at high risk for breast
cancer in accordance with national guidelines.

Background/Rationale: There are over 2 million women who constitute the fastest growing segment of eligible veterans within the VHA. The number of women diagnosed with breast cancer has more than tripled from 1995 to 2012. Chemoprevention reduces the risk of breast cancer by 50-62% in high risk patients. An estimated 10 million women in the U.S. may be eligible, but fewer than 5% of high risk women are offered chemoprevention.

Methods: This is an ongoing feasibility pilot study being conducted at 2 VAMCs (“VAMC 1” and “VAMC 2”) with plans for expansion to 7 more VAMCs. Participants were enrolled at the time of their regular visit to Women’s Health Clinics. Eligibility criteria includes: women age ≥ 35 with no history of breast cancer. After completing a 20 multiple choice questionnaire, 5-year and lifetime risk of invasive breast cancer is calculated using the Gail risk tool (BCRAT). A woman is considered high risk and eligible for chemoprevention if her 5-year risk is ≥ 1.67% or her lifetime risk is ≥ 20%. Eligibility for genetic counseling is based on the Breast Cancer Referral Screening Tool (B-RST), which includes a personal or family history of breast or ovarian cancer and Jewish ancestry.

Results: 72 females (42 at “VAMC 1” and 30 at “VAMC 2”) were enrolled and completed the questionnaire. Of these patients, 17/42 (40%) and 6/30 (20%) had Gail score of > 1.66 and were considered high risk for breast cancer. All 23 females at both facilities had Oncology clinic consultations for chemoprevention. Only 1 female at each center accepted chemoprevention with tamoxifen (“VAMC 1”) and anastrazole (“VAMC 2”). Six patients had telehealth genetic counseling consults.

Implications/Future Directions: Increasing awareness of breast cancer risk status and utilization of prevention options is a critical element in our program to increase screening and provide chemoprevention according to national guidelines in the VHA. Future directions include tool development and national spread of screening efforts.

Introduction: Male breast cancer (MBC) comprises < 1% of all cancers in men and continues to rise. Because of MBC rarity, there is paucity in the literature. Management of MBC is generalized from female breast cancer (FBC). The Veterans Affairs Central Cancer Registry (VACCR) provides a unique source for the study of MBC. The objective of this retrospective analysis was to compare and contrast the characteristics and outcomes of MBC with FBC in the VA population.

Methods: VACCR data from 153 VAMCs were used to analyze the database of VA patients who had breast cancer diagnosed between 1998 and 2013. Primary site codes were identified for breast cancer (50.0-50.9). Data were entered and analyzed using biostatistical software (SAS 9.3).

Results: In total, 6,443 patient records were reviewed, and 1,123 MBC patients were compared with 5,320 FBC patients. The mean age at diagnosis was 70 years for MBS and 57 years for FBC (P < .0001). In patients aged > 50 years, higher numbers of MBC diagnosis (95%) were made compared with FBC diagnosis (72%). Seventy-five percent of patients with breast cancer were white in both genders. More MBC patients (40% in men vs 24% in women) presented with higher disease stage (3 and 4) compared with FBC (21% had ductal carcinoma in situ and 53% stage 1). The dominant histology was ductal carcinoma. No difference in laterality was observed. Estrogen and progesterone receptor-positive tumors were more common in MBC compared with FBC. Forty-five percent and 36% of patients with MBC or FBC, respectively, received hormonal treatment as first course, but fewer MBC patients received chemotherapy and radiation. The mean follow up time was 754 days. As of December 2013, 355 (32%) MBC and 791 (15%) FBC patients died during the course of the study. Males had higher odds of death compared with that of females, but when adjusted for age, race, stage, and grade, survival was better among males.

Conclusions: To the authors’ knowledge, this is the largest series of MBC and FBC completed to date in the veteran population. The results suggested that males were older at presentation and had higher stage of breast cancer compared with that of FBC. The higher mortality rate in MBC may be due to higher stage and/or tumor biology.

Introduction: Male breast cancer (MBC) comprises < 1% of all cancers in men and continues to rise. Because of MBC rarity, there is paucity in the literature. Management of MBC is generalized from female breast cancer (FBC). The Veterans Affairs Central Cancer Registry (VACCR) provides a unique source for the study of MBC. The objective of this retrospective analysis was to compare and contrast the characteristics and outcomes of MBC with FBC in the VA population.

Methods: VACCR data from 153 VAMCs were used to analyze the database of VA patients who had breast cancer diagnosed between 1998 and 2013. Primary site codes were identified for breast cancer (50.0-50.9). Data were entered and analyzed using biostatistical software (SAS 9.3).

Results: In total, 6,443 patient records were reviewed, and 1,123 MBC patients were compared with 5,320 FBC patients. The mean age at diagnosis was 70 years for MBS and 57 years for FBC (P < .0001). In patients aged > 50 years, higher numbers of MBC diagnosis (95%) were made compared with FBC diagnosis (72%). Seventy-five percent of patients with breast cancer were white in both genders. More MBC patients (40% in men vs 24% in women) presented with higher disease stage (3 and 4) compared with FBC (21% had ductal carcinoma in situ and 53% stage 1). The dominant histology was ductal carcinoma. No difference in laterality was observed. Estrogen and progesterone receptor-positive tumors were more common in MBC compared with FBC. Forty-five percent and 36% of patients with MBC or FBC, respectively, received hormonal treatment as first course, but fewer MBC patients received chemotherapy and radiation. The mean follow up time was 754 days. As of December 2013, 355 (32%) MBC and 791 (15%) FBC patients died during the course of the study. Males had higher odds of death compared with that of females, but when adjusted for age, race, stage, and grade, survival was better among males.

Conclusions: To the authors’ knowledge, this is the largest series of MBC and FBC completed to date in the veteran population. The results suggested that males were older at presentation and had higher stage of breast cancer compared with that of FBC. The higher mortality rate in MBC may be due to higher stage and/or tumor biology.

Introduction: Male breast cancer (MBC) comprises < 1% of all cancers in men and continues to rise. Because of MBC rarity, there is paucity in the literature. Management of MBC is generalized from female breast cancer (FBC). The Veterans Affairs Central Cancer Registry (VACCR) provides a unique source for the study of MBC. The objective of this retrospective analysis was to compare and contrast the characteristics and outcomes of MBC with FBC in the VA population.

Methods: VACCR data from 153 VAMCs were used to analyze the database of VA patients who had breast cancer diagnosed between 1998 and 2013. Primary site codes were identified for breast cancer (50.0-50.9). Data were entered and analyzed using biostatistical software (SAS 9.3).

Results: In total, 6,443 patient records were reviewed, and 1,123 MBC patients were compared with 5,320 FBC patients. The mean age at diagnosis was 70 years for MBS and 57 years for FBC (P < .0001). In patients aged > 50 years, higher numbers of MBC diagnosis (95%) were made compared with FBC diagnosis (72%). Seventy-five percent of patients with breast cancer were white in both genders. More MBC patients (40% in men vs 24% in women) presented with higher disease stage (3 and 4) compared with FBC (21% had ductal carcinoma in situ and 53% stage 1). The dominant histology was ductal carcinoma. No difference in laterality was observed. Estrogen and progesterone receptor-positive tumors were more common in MBC compared with FBC. Forty-five percent and 36% of patients with MBC or FBC, respectively, received hormonal treatment as first course, but fewer MBC patients received chemotherapy and radiation. The mean follow up time was 754 days. As of December 2013, 355 (32%) MBC and 791 (15%) FBC patients died during the course of the study. Males had higher odds of death compared with that of females, but when adjusted for age, race, stage, and grade, survival was better among males.

Conclusions: To the authors’ knowledge, this is the largest series of MBC and FBC completed to date in the veteran population. The results suggested that males were older at presentation and had higher stage of breast cancer compared with that of FBC. The higher mortality rate in MBC may be due to higher stage and/or tumor biology.