Purpose: Assess breast cancer (BC) risk, lifestyle factors, post-traumatic stress disorder (PTSD) status, chemoprevention and genetic consultations in women Veterans.
Background/Rationale: By 2020, women using Veterans Affairs Medical Centers (VAMC) will rise to 15%. For US women at high risk of BC, national guidelines (ASCO/USPSTF) recommend chemoprevention and genetic counseling for which fewer than 10% accept.
Methods: A pilot program was conducted at two VAMCs in the Bronx, NY and Washington, DC. Participants were enrolled at women’s health visits or education/awareness events. A questionnaire included the Gail Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Genetics Referral Screening Tool (B-RST), and lifestyle questions. Body mass index (BMI) and PTSD status were determined. Chemoprevention was recommended based on 5-year BCRAT > 1.66%; the B-RST was used for genetic counseling referrals. Chemoprevention candidates were given pre- and post-consultation knowledge questions.
Results: 99 women Veterans aged > 35 years with no personal history of BC, average age 54 years, participated between 2015-2018. Of these 35 (35%) had a Gail score of > 1.66%. Of this subset, 46% had prior breast biopsies and 86% had a positive family history. PTSD was present in 31%. Twenty-six (74%) accepted consultations for chemoprevention; 19% accepted chemoprevention; 37% patients were referred for genetic counseling; and 85% increased their awareness of chemoprevention. Among all participants, 79% had overweight or obese BMIs; 58% exercise weekly; 51% drink alcohol; 14% were smokers and 21% consumed 3-4 servings of fruits/vegetables daily.
Conclusions/Implications: Our study demonstrated that three times as many women Veterans are at increased risk of BC compared to the general population, based on a high rate of prior breast biopsies or positive family history. PTSD rates were nearly 3 times the national average and are implicated in poor adherence to medical advice. Chemoprevention utilization was nearly twice the national average. Lifestyle factors were similar to general population rates and unlikely to impact risk levels. Limitations included self-referrals and the large percentage of patients with a family history of BC, making them more likely to seek screening. As the number of Women Veterans increases, chemoprevention options should follow national guidelines.