Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer

Abstract

Background/Aims: We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST). Methods: RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk. Results: The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST. Conclusion: The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.

Insights into BRCA1/2 Genetic Counseling from Ethnically Diverse Latina Breast Cancer Survivors

“…Recent research has validated the efficacy of the 6-Point Scale, a screening tool to identify lowincome women for referral to genetic counseling, requiring minimal time investment by primary care physicians and their staff. (Stewart et al 2016).…”

Mental Illness and BRCA1/2 Genetic Testing Intention Among Multiethnic Women Undergoing Screening Mammography

“…The authors collected demographic characteristics, such as age, highest education level, and race/ethnicity, and breast cancer risk factors, including parity, age at first live birth, menopausal status, number of first-and second-degree relatives with breast cancer, and any blood relative who ever tested positive for a BRCA1/2 gene mutation, based on the SPS family history screener (Stewart et al, 2016). Perceived breast cancer risk was measured with one item that asked, "Compared to other women the same age, do you think your chance of getting breast cancer is: higher, same, or lower?"…”

“…Participants consented to participate in a survey study, called Know Your Risk: Assessment at Screening (KYRAS) for breast cancer, at the time of screening mammography (McGuinness et al, 2018). The KYRAS survey included the Six-Point Scale (SPS), a family history screener that determines eligibility for BRCA1/2 genetic testing based on USPSTF guidelines (Joseph et al, 2012;Stewart et al, 2016). Scores greater than 6 on the SPS warrant referral for genetic testing (Stewart et al, 2016).…”

“…The KYRAS survey included the Six-Point Scale (SPS), a family history screener that determines eligibility for BRCA1/2 genetic testing based on USPSTF guidelines (Joseph et al, 2012;Stewart et al, 2016). Scores greater than 6 on the SPS warrant referral for genetic testing (Stewart et al, 2016). Among those who agreed to be contacted again for future studies, these women were later contacted by telephone for participation in the mental health substudy if they met the following inclusion criteria: aged 18 years or older; met family history criteria for BRCA1/2 genetic testing, based on the SPS family history screener; spoke English or Spanish; and provided verbal or written informed consent.…”

Uptake of genetic testing for germline BRCA1/2 pathogenic variants in a predominantly Hispanic population

“…The Gail model was used to estimate 5-year risk of invasive breast cancer [20]. The questionnaire included the Six-Point Scale (SPS), a family history screener to determine eligibility for BRCA1/2 genetic testing based upon USPSTF guidelines that has been validated in populations of low income, multiethnic women [21,22]. The SPS is a simplified questionnaire that can be administered in a low-cost, efficient manner, consisting of ten questions that assess eligibility for HBOC genetic testing based upon USPSTF guidelines.…”