Fewer than 10% of cancer patients undergo hereditary testing, meaning the vast majority of high-risk individuals are never identified within standard clinical workflows. As accreditation programs begin requiring formal risk assessment, health systems face growing pressure to catch these patients systematically rather than one referral at a time.
In a webinar hosted by Becker’s Healthcare and sponsored by Ambry Genetics, Stephanie Spaulding, genetic counseling clinical manager at VHC Health in Arlington, Va., walked through how her team moved from manual, inconsistent screening to a scalable, automated model — and the operational lessons that made it sustainable.
Editor’s note: Quotes have been edited lightly for length and clarity.
1. The identification gap is wide, and patients want it closed
Ms. Spaulding estimates about 1 in 20 people carry a genetic mutation that raises their cancer risk, and most never find out — while more than 90% of patients who qualify for a breast MRI based on family history never receive one. She also pointed to one JAMA study showing most high-risk breast cancer patients wanted genetic testing but only about half were tested, often because a provider never recommended it.
“Patients really want this testing. They even talk to their doctors about it, but we aren’t recognizing when we can implement it and really capitalize on delivering this service to our patients,” Ms. Spaulding said.
2. Manual screening doesn’t scale, so VHC Health built a business and compliance case
Paper questionnaires couldn’t handle risk calculations or keep pace with guidelines that change several times a year, and an EMR-built tool carried a heavy IT burden, Ms. Spaulding noted.
She explained how a National Accreditation Program for Breast Centers mandate to use risk-assessment screening gave her leverage for interdepartmental and administrative buy-in, while downstream-revenue data — recurring breast MRIs, genetic counseling referrals and preventive procedures — made the financial case.
“Hospital administration is always going to do hospital administration things, so you have to justify your cost,” Ms. Spaulding said.
3. An automated, lab-agnostic tool casts a wider net
The Ambry CARE Program (Comprehensive Assessment, Risk and Education) collects medical and family history digitally before a patient’s mammogram, applies National Comprehensive Cancer Network (NCCN) testing criteria and calculates lifetime breast cancer risk using the Tyrer-Cuzick model.
Results flow into the EMR and into the mammogram report sent back to the referring physician. Every screening-mammogram patient and every Center for Breast Health patient is invited, Ms. Spaulding noted — and because the tool is lab-agnostic, VHC Health keeps the freedom to choose the best testing lab for each patient.
4. Early results show measurable clinical impact
In its first year in women’s imaging, VHC Health sent nearly 23,000 invitations and reached a 67% completion rate — just over 15,000 assessments — according to Ms. Spaulding. Roughly a quarter met genetic testing criteria; of 960 tested, 95 were positive, and more than 3,300 were flagged as high-risk for breast cancer.
High-risk breast visits doubled after launch, Ms. Spaulding said, and breast surgery volume rose 8% in 2025 with the same number of surgeons. She said she hears a version of the same reaction from patients every week: “Oh my gosh, I had no idea I was at high risk for breast cancer. Thank you so much.”
What it takes to sustain the model
The hardest parts weren’t clinical, Ms. Spaulding emphasized — they were the IT integration and patient education, the latter eased by rewriting text and email invitations to explain that the assessment is optional, free and HIPAA-compliant. Her advice to peers is to lean on IT early and advocate relentlessly. “No one is going to advocate for you. You need to be your own best champion,” Ms. Spaulding said.
Next, VHC Health plans to extend the Ambry CARE Program into colorectal, endometrial and gastric cancer screening in line with expanded NCCN guidance, and is weighing a move to point-of-care testing to ease scheduling bottlenecks.
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