Risk assessment added to breast cancer campaign
NCI survey focuses on leading risk factors
AstraZeneca, the international pharmaceutical firm that helped pioneer worksite mammograms in the late 1980s, is again paving the way in employee breast health by launching a breast cancer risk assessment program for its women employees.
"Our original [mammogram] program began in 1989, and it’s my understanding that for a number of years only one or two companies in the Unites States offered such screenings," notes Sue Cox, RN, occupational health nurse in the Wilmington, DE, U.S. headquarters of AstraZeneca. (Editor’s Note: The original 1989 program was provided by the U.S. predecessor firm of the company that is now called AstraZeneca. AstraZeneca manufactures a number of oncology drugs.)
This long-standing program is deeply entrenched in the corporate culture, providing a firm foundation for the new risk assessment tool.
"In an employee survey taken a year ago, we found that 95% of the women here are followed on a regular basis for their mammography," notes Cox, who says the company currently employs about 1,500 women, not counting retirees or part-time workers.
"This is not a fad," Cox adds. "Everybody talks about [breast cancer screenings] everywhere I go. They see my face and they see mammograms’ walking down the hall. I think it’s because we care so much; it’s a really good feeling to come to work when you know someone is looking out for you."
Cox’s office also offers emergency care, dispensary care, and advice. For all of the reasons note above, she says, regular mammogram screenings have become "a given. You get to be a friend."
NCI provides tool
The new breast cancer risk assessment tool, which was added in October 1999, was developed by the National Cancer Institute (NCI), Bethesda, MD, and then approved by the U.S. Food and Drug Administration.
There are only six questions, and they do not address every single known risk factor for breast cancer. However, as the NCI explains on its Web site (www.nci.nih.gov): "Either evidence that these [other] factors contribute to breast cancer risk is not conclusive, or researchers cannot determine how much these factors contribute to breast cancer risk as precisely as with the factors listed above."
Here, then, are the six survey questions. NCI comments are added in italics to explain the significance of a particular question:
1. How old are you? The risk of developing breast cancer increases with age. The majority of breast cancer cases occur in women older than age 50.
2. How old were you when you had your first menstrual period? Women who had their first menstrual period before age 12 have a slightly increased risk of breast cancer.
3. How old were you when your first child was born? Women who had their first full-term pregnancy after age 30 and women who have never borne a child have a greater risk of developing breast cancer.
4. How many of your sisters, daughters or mother have had breast cancer? Having one or more first-degree blood relatives who have been diagnosed with breast cancer increases a woman’s chances of developing this disease.
5. Have you ever had a breast biopsy? A breast biopsy is when the doctor removes tissue from your breast to test for cancer. Women who have had breast biopsies have an increased risk of breast cancer, especially if the biopsy showed a change in breast tissue known as atypical hyperplasia. Those women are at increased risk because of whatever prompted the biopsies, NOT because of the biopsies themselves.
6. What is your race? White women have greater risk of developing breast cancer than black women (although black women diagnosed with breast cancer are more likely to die of the disease).
Privacy is maintained
The survey is provided to AstraZeneca employees on a computer disk or on paper, and determines their risk score over a five-year period and their lifetime. The score is reported in numeric form, with any score over 1.66 being considered high risk.
"Each person who comes in for a breast exam (80% to 85% of the female population) is given a letter explaining the survey, and can then take the survey if they want to," says Cox. "Those who participate give us their physician’s address. We get their survey, score it, then send that information directly to their doctor’s office.
Employees wishing an even greater level of privacy can visit the company Web site and take the survey, do their own scoring, and take the results to their doctor.
"In any case, the employee can then sit down with their doctor and decide what to do," says Cox. "We don’t want to do the counseling ourselves. I’m not a physician, and we don’t have a complete health history."
Information about this new screening was put on the Web site last spring to help build early awareness. Cox has been pleased with the response.
"Several employees have said, Yeah, this is great,’" she notes. "The survey is completely voluntary, and some have refused to take it, but the majority have taken it."
[Editor’s Note: For more information and free publications on the prevention, early detection, diagnosis, and treatment of breast cancer, call the National Cancer Institute’s Cancer Information Service at (800)-4-CANCER. Specifically trained staff provide the latest scientific information in understandable language — in both English and Spanish. People with TTY equipment, dial (800) 332-8615. For more information on the AstraZeneca program, contact: Susan Cox, AstraZeneca, 1800 Concord Pike, Wilmington, DE 19850. Telephone: (302) 886-5672.]
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