# Evaluating the Implementation and Maintenance of a Breast Cancer Risk-Assessment and Prevention Program

## TL;DR

This study evaluates a breast cancer risk and prevention program, finding that high-risk patients are more likely to start and maintain chemoprevention, and that sustainability depends on program adaptation and evaluation.

## Contribution

The study provides insights into the sustainability and effectiveness of a breast cancer risk-assessment program using the RE-AIM framework and PSAT tool.

## Key findings

- High-risk lesion patients had significantly higher chemoprevention initiation and maintenance rates compared to non-HRL patients.
- Program sustainability was supported by adaptation, ongoing evaluation, and environmental support, with an average PSAT score of 6.13 out of 7.
- As the program matured, the time from first visit to chemoprevention initiation decreased.

## Abstract

Understanding factors associated with successful high-risk breast health programs can aid in the development of similar initiatives. This study evaluated the impact of the Breast Cancer Personalized Risk Assessment, Education, and Prevention (B-PREP) program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Patients evaluated from January 2017 to September 2024 were retrospectively reviewed from a prospectively maintained database. The number of patients seen over time was used to measure “reach.” Chemoprevention uptake was used to measure “effectiveness.” We surveyed B-PREP clinicians and staff using the validated Program Sustainability Assessment Tool (PSAT), to assess factors associated with sustainability (“implementation” and “maintenance”).

The study identified of 5972 B-PREP patients, 1860 (31.1 %) of whom had a high-risk lesion (HRL). The average time from the first visit to chemoprevention initiation was 57 weeks (median 24 weeks; range, 0–370 weeks). The overall chemoprevention initiation rate was 7.38 %, significantly higher for the patients with HRL (HRL [22.5 %] vs non- HRL [0.5 %]; p < 0.001). Sustained chemoprevention for ≥6 months also was higher with HRL (HRL [15.4 %] vs non-HRL [0.4 %]; p < 0.001). Ten stakeholders evaluated sustainability using the PSAT. The overall average was high (6.13 of 7). Domains on program adaptation (6.69), ongoing program evaluation (6.64), and environmental support (6.55) had the highest average.

The comprehensive risk program increased annual chemoprevention use as clinic volume grew. As the program matured, time to chemoprevention initiation decreased. Clinicians noted that a supportive environment, regular program evaluation, and adaptation to changing circumstances were key features contributing to the sustainability of a successful high-risk program.