As an OB-GYN, Dr. Candace Westgate has those days when she must deliver bad news—a cancer diagnosis—to a patient.
But in recent years, some of those cases have come using genetic testing to identify high-risk patients earlier to preempt or prevent the disease.
It’s one of the reasons Westgate became a champion of the Early All-Around Detection (AHEAD) Program at Adventist Health, the 21 hospital-based health system where she works in St. Helena, California. Adventist Health operates hospitals in California, Oregon, and Hawaii.
AHEAD is a population hereditary cancer risk assessment initiative that focuses on genetic testing to identify risk factors for breast, ovarian, pancreatic and other cancers. The goal is to identify high-risk patients, intervene earlier and reduce hereditary cancer deaths.
Hereditary cancers, which tend to be earlier onset and more aggressive, account for up to 10% of new diagnoses, according to the National Cancer Institute.
Of that 10%, around 1% will have a positive result for a hereditary cancer predisposition. “We’re talking about small numbers here but we’re talking about a big impact—preventing cancers and saving lives. Not only for the patients with the gene mutation but the rest of their family,” Westgate said.
Technology is making it easier for Westgate and her colleagues to identify, evaluate and manage entire patient populations based on individual risk factors. Adventist Health is using software from CancerIQ to help automate and streamline its cancer risk assessment program.
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“This program is one reason why I wake up and do my job every day. It’s not just the one mom that’s in front of me—I’m impacting her children and her sister. I can have a huge impact on her entire network,” Westgate said.
And thinking of that one patient who was recently given bad news, Westgate said, “I was not able to prevent cancer for her and we could have if we had known this information earlier."
Technology helps to scale cancer screening
The AHEAD program started in 2014 as a pilot program, spearheaded by Westgate, to offer point-of-care genetic testing at the ob-gyn practice. Prior to that, most patients were not making it to their appointments with genetic counselors when they were referred to them.
As St. Helena is located in rural Napa Valley, most patients must travel up to two hours one-way to San Francisco or Davis to receive genetic counseling or to receive medical care if they are found to be at high-risk for cancer.
“I realized we had to do something better for our patients here in a rural setting,” Westgate said.
Adventist Health expanded the AHEAD program to include specialists in gynecology, internal medicine, urology, oncology/hematology, dermatology and breast and reconstruction surgery—what the health system calls “circles of care” to improve care coordination and drive better outcomes for patients identified as high-risk.
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Adventist Health began working with CancerIQ in early 2018 as part of its AHEAD program.
CancerIQ’s software analyzes family history, runs predictive risk models, and automates National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN guidelines) to more efficiently identify candidates for genetic testing.
Clinics that have implemented the genetic cancer screening have had dramatically higher rates of routine cancer screening for all of their patients. For the vast majority of patients at average risk, this promotes early detection when cancers are most curable, the health system said.
The health system recently expanded its partnership with CancerIQ to integrate the cancer risk assessment and management platform into its Cerner electronic health record which helps to streamline and automate the process.
"The NCCN guidelines as to who meets the criteria for genetic testing are changed and updated every six months. For us as clinicians to stay on top of the new guidelines, it can be very difficult. The software is automatically updated with the new guidelines," Westgate said. "It enables us to offer this genetic testing and counseling even though we’re in a primary care office."
CancerIQ executives call the software a "cancer risk clinic in a box" that automates the most time-consuming administrative tasks. The platform includes predictive analytics and screening tools to identify at-risk patients, clinical guidance, a digital genetic test ordering platform, and patient management and education tools.
Nearly 8,000 Adventist Health patients have been screened through the AHEAD program to date.
Brenda Munson, one of Westgate’s patients, personally benefited from genetic testing and counseling.
“I learned I had an 87% chance of getting breast cancer and 60% to 70% chance of getting ovarian cancer,” Munson said in a statement. “These were just too high of numbers for me to live with, so I opted to have preventive surgeries. I'm really lucky because I was able to make decisions based on having these statistics.”
The AHEAD program is now in 25 clinics mostly in the northern California region, but the program is now being rolled out in central and southern California.
“It’s exciting what a small, grassroots, quality improvement project in my clinic has turned out to be, and just in the last two years,” Westgate said. "I want to see this program in every single clinic within Adventist Health so that we can have a much bigger impact on cancer prevention for our patients."
The investment Adventist has made in technology and clinical education has paid off for the health system, its providers and patients, Feyi Olopade Ayodele, CancerIQ CEO and co-founder, said in a statement.
“Adventist leadership is ensuring that genetic testing is not only a part of their innovation and specialty service line development strategy but a foundational part of their quality assurance, patient safety, and population health management initiatives," Ayodele said.