At a community outreach event, Lynne R. Tamburrino, APN, encountered a 60-year-old woman who had never had a mammogram.
“I made her an appointment right then and there,” said Tamburrino, who’s on a team that is seeking out people at high risk for breast cancer at libraries and other public venues. She is a nurse practitioner with Atlantic Medical Group, part of Atlantic Health.
In 2019, Atlantic Health established the High-Risk Breast Cancer Prevention and Surveillance Program, aimed at identifying and screening patients at high-risk for breast cancer and ensuring they are connected to appropriate care. To date, the program has screened thousands of patients and expanded its services across eight Atlantic Health sites, ensuring consistent and standardized care throughout the health system.
To be eligible for the program, patients must meet one or more of these criteria:
- Be a confirmed carrier of a genetic mutation that increases their risk for breast cancer.
- Have a family member who is a carrier of a mutation that puts them at risk for breast cancer.
- Have a male relative with breast cancer.
- Have a personal lifetime risk of 20% or more—calculated by a Breast Cancer Risk Assessment Tool (Tyrer-Cuzick Model).
- Have one or more close relatives with a history of breast cancer.
- Be of Ashkenazi Jewish background
- Have a history of an abnormal breast biopsy.
- Have a history of radiation therapy to the chest between ages 10 and 30.
Atlantic Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
This effort is an example of strategically coordinated care with nurse practitioners and physician assistants taking the lead in identifying patients who might benefit from the program and partnering with physicians and other team members on the patient’s overall care. The initiative shows how Atlantic Health’s approach is “enhancing care,” said Judy Washington, MD, a family physician and associate chief medical officer at Atlantic Medical Group.
Marcella Fornari, DO, a breast surgeon at Atlantic Breast Associates in Morristown, New Jersey, said her “practice is an extremely cohesive unit.” She noted, as she spoke from her Rockaway, New Jersey, office, “My nurse practitioner's literally in the office behind me. We're seeing patients at the same time. So, what’s really nice is we’re seeing patients simultaneously. … It’s really nice to have that comradery.”
“Even the patients feel like: OK, I’m easily being funneled through and sent to where I need to be, and it's all one team and everybody knows me and knows each other—which is really helpful for things like this,” Dr. Fornari added.
“We work closely with all these providers in the office, not only with the high-risk program, but with our practice in general,” said Faith Goldman, MD, a fellowship-trained breast surgical oncologist with additional board certification in ob-gyn with Atlantic Medical Group. “We know them very well. We are very blessed to have both nurse practitioners and physician assistants who have a tremendous amount of personal and collective breast-specific experience.”
The program was launched at Atlantic Health Chilton Medical Center through a grant that facilitated the distribution of iPad-based questionnaires to patients at the time of their mammography. These digital risk assessments enable the early identification of people at high risk for breast cancer based on standardized scoring algorithms.
Once a patient is identified as high risk, administrative staff follow up to ask whether they would like to be part of the program, then set up appointments within Atlantic Health, depending on which site the patient would like to be seen. A small blurb at the end of the mammogram also informs the ordering physician that their patient was identified as high risk.
The process has significantly increased the capture rate, said Tamburrino. As the program has grown, so has the patient-satisfaction rate, with ob-gyns and primary care physicians receiving a lot of positive feedback.
Big boost to screening
Since the enrollment of its first patient, the program has expanded from 89 to 2,300 patients screened in 2024. Physicians working at Atlantic Health’s Morristown and Chilton sites have diagnosed more than 15 early-stage breast cancers, identified more than 12 atypical lesions and discovered more than a dozen significant genetic mutations. The other six sites that have since adopted the program are in the process of starting data collection, said Tamburrino, who runs the program.
And when a patient has an abnormal finding or needs a higher level of care, physicians are ready to take over.
“Whenever we have patients who might need a higher level of care such as an imaging abnormality that might need a biopsy or they may require some type of surgical intervention, it's quite nice because we can jump right in and take that higher level of care,” said Dr. Goldman. “Then we can step back and know that we have potentially generated a new plan for the patient for the long run or continuing a plan for high-risk surveillance that they've already had.
Initial data shows that the screening saves lives, said Atlantic Health professionals involved. No one enrolled in the program has died of breast cancer. When patients are diagnosed with breast cancer, it is usually at an early diagnostic stage.
Such outcomes are “what we strive for with all of our team members,” said Elizabeth DeSantis, MSN, RN, CPNP-AC, a nurse practitioner and lead nonphysician provider with Atlantic Medical Group. She noted that the program enables a “bridge to patient care and better patient outcomes.”
Tamburrino noted that 95% of breast cancers found on routine imaging are curable “and these patients are getting more than routine imaging. It’s just a fantastic thing and it really is quite satisfying. The amount of positive feedback that I get from patients is heartwarming.”
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