For Clinicians

 

Welcome to the Athena Breast Health Network, a unique collaboration among the five University of California medical centers, their affiliates, and many other public and private partners.


 Delivering Better Breast Health Care

Athena will revolutionize care for breast cancer by designing and testing new system-wide approaches to research, technology, and health care delivery.

Our goals are to

Personalize patient care by assessing and communicating individuals’ breast cancer risk to their clinicians

    • Build better predictive risk models to drive the development of tailored screening and prevention strategies

    • Identify women and families at high risk for hereditary cancer and offer them consultations with an Athena Breast Health Specialist, genetic counseling, gene testing when indicated, as well as breast cancer risk reduction and prevention interventions

    • Identify low-risk patients at the time of diagnosis and offer more tailored treatment options, thereby reducing unnecessary morbidity from overtreatment

    • Identify patients at high-risk for recurrence and death based on their tumor biology, response to therapy, co-morbidities, and lifestyle factors as well as develop and offer tailored interventions to those high-risk patients to reduce mortality

    • Create a repository of clinical and biological data and specimens and a set of analytic tools to conduct comparative effectiveness studies that will provide feedback and opportunities to accelerate learning and continuously improve treatment and intervention option

Athena will initially recruit 150,000 women who are being screened for breast cancer and who will be followed for decades through the five UC cancer centers. Together, we can improve breast health care for both affected and unaffected patients while facilitating cutting-edge breast cancer research.


What Athena Means for You and Your Patients

Athena will help you:

    • Provide decision support for patients, including recommendations for follow-up care

    • Coordinate access to resources, genetic counselors and treatment and prevention specialists when indicated.

Risk Assessment Models and Risk Thresholds

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Gail Risk Assessment Model

A statistical tool used to estimate a woman’s risk of developing invasive breast cancer. This tool incorporates a woman’s age, age at birth of first child, age at menarche, history of biopsy and atypia, and first-degree family history of breast cancer to provide an estimate of short- and long-term breast cancer risk. This model is also known as the National Cancer Institute’s Breast Cancer Risk Assessment Tool.

BRCAPRO Model

A predictive tool using a woman’s personal and family history of cancer to estimate the probability that she carries a BRCA1 or BRCA2 gene mutation, which increases the risk of breast and ovarian cancer. It also calculates the short- and long-term risk of developing breast and ovarian cancer. BRCAPRO incorporates maternal and paternal family history of breast and ovarian cancers, ages of diagnosis, and takes Ashkenazi Jewish heritage into account. It is often thought to be the gold standard in predicting hereditary risk.

Clinical Guidelines

The US Preventive Services Task Force recommendations on genetic risk assessment for breast cancer and the National Comprehensive Cancer Network genetic screening guidelines for familial cancer syndromes suggest evaluation and genetic counseling based on the family history of a pattern of cancers including breast, ovarian, male breast, and other cancers. Women who do not meet the threshold on any of the models may meet these guidelines for identification of high risk families.

Risk Thresholds

Women who fit the following criteria may be referred to an Athena Breast Health Specialist to discuss their risk and possible methods for reducing this risk:

  • Risk of BRCA mutation 10% or higher or other significant hereditary risk

  • A Gail score in the top 5% of the population distribution by age

  • Meets National Comprehensive Cancer Network genetic screening guidelines for genetic counseling, and gene testing

  • Meets US Preventive Services Task Force recommendations on genetic risk assessment for breast and ovarian cancer

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 Frequently Asked Questions:

 

What does this mean for my patient’s care?

Every woman referred to a UC mammography center will complete an Athena breast health questionnaire. This will be used to create a personalized breast cancer risk profile. Your patients will also be given the option to share their personal health information and provide a blood or saliva specimen.

Currently, women identified to be at an elevated risk for developing breast cancer will receive a personalized risk report explaining what contributes to their elevated risk. You will also be notified of your patient’s risk factors. And, eventually, we hope to provide all women with a risk report detailing their likelihood of developing breast cancer.


What happens if Athena identifies one of my patients as being at elevated risk for breast cancer?

    • Both you and she will receive a copy of her personalized risk report detailing the factors that contribute to her elevated risk.

    • An Athena Breast Health Specialist will be available to schedule a consultation with her to discuss her risk profile and address any concerns she may have.

    • After the visit, the Breast Health Specialist will send you a consultation note summarizing the visit and indicating referrals made or follow-up recommended.

What is an Athena Breast Health Specialist?

Athena Breast Health Specialists have special training in breast cancer risk assessment and are part of the clinical team. Many Breast Health Specialists are licensed genetic counselors. Using the latest decision-support tools and evidence on breast cancer risk factors, the Breast Health Specialist works with each patient to help her better understand her risk and connect her with the best preventive care.

Any patient who wishes to see a Breast Health Specialist should enroll first in the Athena Breast Health Network as part of her mammography visit at a UC or Sanford center.


What are the cost and insurance issues related to Athena?

There is no fee for patients to consult with the Athena Breast Health Specialist. If the Breast Health Specialist makes referrals for other services – including genetic counseling and testing – she will review fees and insurance issues with the patient. The Athena risk profile will become part of the patient’s medical record. Federal and state legal protection exists to protect patients from health insurance discrimination based on breast cancer risk factors.


How will Athena affect my practice?

Athena will:

  • Help you determine your patient’s risk of developing breast cancer by using personalized risk assessment profiles

  • Assist you in accessing resources, specialists, genetic counselors, prevention programs and breast health information

  • Offer access to an Athena Breast Health Specialist and if needed, to genetic counseling services

  • Provide decision support for patients, including recommendations for follow-up care

  • Communicate with you about your patient every step of the way


How can I get more information if I have questions about my patient or her risk assessment?

Contact your specific Athena site representative (see Contacts).


PCP Risk Assessment Talking Points

Primary Care Physicians Risk Assessment Talking Points