Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer

Susan L Stewart, Celia P. Kaplan, Robin Lee, Galen Joseph, Leah Karliner, Jennifer Livaudais-Toman, Rena J. Pasick

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background/Aims: We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST). Methods: RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk. Results: The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST. Conclusion: The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.

Original languageEnglish (US)
Pages (from-to)342-351
Number of pages10
JournalPublic Health Genomics
Issue number6
StatePublished - Jan 1 2017


  • Genetic counseling referral
  • Hereditary breast cancer
  • Low income
  • Screening tool
  • Validation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Genetics(clinical)


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