Electronic health records contain dispersed risk factor information that could be used to prevent breast and ovarian cancer

Abstract

Objective The genetic testing for hereditary breast cancer that is most helpful in high-risk women is underused. Our objective was to quantify the risk factors for heritable breast and ovarian cancer contained in the electronic health record (EHR), to determine how many women meet national guidelines for referral to a cancer genetics professional but have no record of a referral. Methods and Materials We reviewed EHR records of a random sample of women to determine the presence and location of risk-factor information meeting National Comprehensive Cancer Network (NCCN) guidelines for a further genetic risk evaluation for breast and/or ovarian cancer, and determine whether the women were referred for such an evaluation. Results A thorough review of the EHR records of 299 women revealed that 24 (8%) met the NCCN criteria for referral for a further genetic risk evaluation; of these, 12 (50%) had no referral to a medical genetics clinic. Conclusions Half of the women whose EHR records contain risk-factor information meeting the criteria for further genetic risk evaluation for heritable forms of breast and ovarian cancer were not referred.

Value of a genetics clinic evaluation in identifying women at risk for hereditary breast‐ovarian cancer syndrome

“…They found 12.05% of the survey respondents met criteria for referral compared to 1.43% of women who met criteria based on structured and free-text data in the EHR. In our previous work, we found personal or family cancer history and other risk factors available in the EHR that met NCCN criteria for referral for 8% of patients, but only half of these had been referred to genetics (Payne et al, 2020).…”

“…The 56 subjects for our study were drawn from a randomly selected cohort of 9,573 women ≥30 years old who had been seen in University of Washington (UW) Medicine clinics 5 or more times or had been hospitalized two or more times in UW Medicine hospitals. This cohort was created as part of another study (Payne et al, 2020). These criteria were chosen so that there would be sufficient material in the electronic health record to review.…”

“…The information sought was found in both free-text and structured format in the EHR in Epic, Cerner, and Care Everywhere across multiple clinical sites, as well as in pathology reports, history provided in imaging requisitions, and in scanned outside documents (Payne et al, 2020). Manual review of each chart took up to one hour.…”

“…Genetic counseling for cancer prevention remains underutilized, with the most common reason being lack of referral (Swink et al, 2019). We have found that family history information is already available in the EHR but is dispersed across many providers' clinic notes (Payne et al, 2020). Although EHR alerts already fill simple healthcare gaps by reminding patients and clinicians when a flu vaccine or mammogram are overdue, a 'smart' healthcare approach can be envisioned in which the EHR recognizes important missing information that a primary care provider could ask the patient.…”

Searching the PDF Haystack: Automated Knowledge Discovery in Scanned EHR Documents

“…As part of the study of risk factors for heritable cancer in the EHR, 8 we studied records of a random sample of 299 women 30 years of age who were seen more than five times or hospitalized two or more times at the University of Washington (UW) Medicine health system in Western Washington state between April 2018 and April 2019. For the primary study, the entire EHR was manually reviewed to identify risk factors for heritable breast and ovarian cancer taken from the National Comprehensive Cancer Network (NCCN) Guidelines for Hereditary Testing Criteria, Version 1.2020.…”