December 28, 2017

Breast cancer prevention success is historic

Kaiser Permanente’s Hereditary Cancer Risk Center using cutting-edge tool to eliminate cancers before they happen.

A mammogram is a key tool for detecting breast cancer medical experts say, and Kaiser Permanente has always taken that clinical guidance to heart. The not-for-profit health care organization has been recognized for years as having the highest percentage of members receiving regular mammograms.

This is a huge benefit to women because more screenings for the right women equal more cancers found at early stages, and more lives saved.

But how does Kaiser Permanente have a screening rate of better than 85 percent when the national average is 65 percent? The nation’s largest integrated health system doesn’t just wait for women who are due for mammograms to contact their physician and ask to be tested. To have the highest rated health plan in the nation for breast cancer screenings for an unprecedented six years in a row, Kaiser Permanente employs some of the nation’s greatest medical minds and state-of-the-art communication tools to educate women on the benefits of screening. It also makes it easy and convenient for them to get their mammograms done.

“A woman who catches her breast cancer in stage 1 has close to a 100 percent chance of survival,’’ said Pat Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan and Hospitals. “And our evidence-based protocols, electronic medical record, and the dedication of our entire organization, particularly our health care teams, provides the greatest chance of finding the disease as early as possible.”

Kaiser Permanente’s clinical care teams, led by physicians, reach out to members who need breast cancer screenings and make it easy schedule mammograms.

“More screenings for women who need them means we can catch cancers earlier, thereby leading to less invasive treatment, improved health outcomes, and better quality of life for our members,” said Michael Kanter, MD, executive vice president and chief Quality officer, The Permanente Federation, the national organization for the more than 21,000 physicians who exclusively provide care to Kaiser Permanente’s members.

Catch it before it happens

Another way to get ahead of breast cancer is to prevent it before it happens, and Kaiser Permanente geneticists and genetic counselors are playing a key role in doing just that by encouraging patients to provide a family history via electronic surveys.

Kaiser Permanente is piloting a number of projects where members fill out their family history information using an online tool. The tool will then run an inherited risk calculation to help determine if a patient is at higher risk than the general population. Those who have a higher cancer risk will be offered a consultation with their local Kaiser Permanente Genetics Department, and if appropriate, be offered genetic testing.

“Catching breast cancer early begins with identifying members who are at higher risk of having an inherited predisposition to diseases like cancer and other disorders before they strike,” said Bethan Powell, MD, lead of the Hereditary Cancer Risk Program in Northern California.

One family’s story

Three adult women who are sisters and one child in a family room playing with a princess castle with little girl
The Brambila sisters have all been tested for breast cancer, including (from left) Adriana holding daughter Sophia, Minerva and Maricela Brambila.

One family that benefited from genetic counseling and genetic testing were the Brambila sisters, Kaiser Permanente members in Baldwin Park, California. After the eldest sister, Minerva, was diagnosed with stage 3 cancer, she had genetic counseling and tested positive for a mutation in the BRCA2 gene that leads to an increased risk of breast cancer and/or ovarian cancer. Her sisters, Maricela and Adriana, who were cancer-free at the time, also tested positive for the BRCA2 mutation.

If members — like the Brambila sisters — test positive for carrying a mutation associated with breast and ovarian cancer risk, their local Hereditary Cancer Risk team will meet with them to help them understand the choices they can make to avoid breast and ovarian cancer entirely. Options include prophylactic surgery and heightened surveillance to detect cancer at its earliest phase.

After counseling, Adriana decided to undergo a mastectomy when a lump in her breast was biopsied and came back positive for early stage cancer. Although Maricela did not have cancer, she knew her risk was great and she decided to get a preventive mastectomy.

“Genetic counseling and testing is evolving and becoming more and more targeted,” said Monica Alvarado, a licensed genetic counselor and regional genetic services administrator for Kaiser Permanente in Southern California. “But that journey to finding life-threatening conditions is aided greatly when members tell us their family history. I tell my patients: If you don’t know your family history, talk to that inquisitive relative who knows all the family secrets and ask them about the family’s cancer history. Then take that information to your doctor.”