There are many women, as well as some men, who would benefit from evaluation in a high-risk breast clinic.
There are many women, as well as some men, who would benefit from evaluation in a high-risk breast clinic, a service we now offer at St. Mary’s Breast Health Center. The goal of such a clinic is to be proactive and often preventative in the management of patients who may have factors that place them at higher risk for breast cancer. These risks may be personal history, family history, or an already diagnosed breast abnormality.
How do you determine if someone is at high risk?
Let’s address personal history first. Breast cancer development can be linked to hormonal exposure over a person’s lifetime. Breaks in that exposure occur with pregnancy and breastfeeding, meaning that the more pregnancies a woman has, particularly before age 35, the more breaks she gets from hormonal exposure. Breastfeeding has many benefits and has been associated with reduced rates of breast cancer.
Is there science showing reduced risk for women who breastfeed?
Yes. One study showed that for every 12 months of breastfeeding, women can decrease their risk by 4.3%. There are studies showing benefits ranging from 4.3% reduction per 12 months of breastfeeding to as high as a 50% decrease for two years of breastfeeding.
There is also data suggesting a significant decrease in ovarian cancer. These factors alone are strong support for breastfeeding. But breastfeeding also provides health benefits for the baby and a bonding experience between mother and child. Of course, we can’t leave out the fact that weight loss back to pre-pregnancy weight is often hastened by breastfeeding! All-in-all, it’s a win-win for everybody.
Are there other important aspects of hormone exposure?
Not only are breaks in hormone exposure important, but also the duration of exposure matters, so a late onset of menstruation and an early onset of menopause is beneficial. Obviously, these are not factors a woman can control, but they do weigh in when determining a women’s level of risk.
What other risk factors put women at high risk?
Another risk factor for women may be a prior biopsy showing what is called a “high-risk lesion” that places her at increased risk for breast cancer. This finding often will include terms such as atypia or lobular carcinoma in situ among others. Management and follow-up strategies will be determined at your visit.
When should I get a risk assessment?
The first time a woman’s risk assessment may (and I would say should) occur is at her first mammogram. There are multiple risk assessment models available: Tyrer-Cusick (Ibis), BRCAPRO, Gail, e.g. At St. Mary’s Breast Health Center and imaging center, we currently use Tyrer-Cusik. Information you provide at the time of your mammogram will be entered into an online calculator that will then provide your risk as a percentage score, which we will provide to you as well. If that number is 20% or higher, there is data to suggest you may be at higher risk. If this is the case, a referral to the High-Risk Clinic at St. Mary’s Breast Health Center would be appropriate.
What happens next?
At your first visit to our High-Risk Clinic, you will be seen by myself and a thorough history and examination will occur. If there are any findings on examination, these will be addressed. If you have a normal exam, we will discuss management of your elevated risk. This may involve incorporation of an MRI in your surveillance along with your mammogram.
Typically, I recommend these on an alternating staggered schedule where you do yearly MRIs and yearly mammograms. What this means is that you would get an MRI followed by a mammogram in 6 months, then an MRI in 6 months and so on. This allows a more frequent evaluation of your breasts, incorporating a test that is more sensitive than mammography alone. Of course, we would fully discuss the risks and benefits of adding MRI into your surveillance.
I often tell patients that an MRI’s strength is also its weakness. It is very sensitive, so it would likely pick up cancers quite early. But because it’s very sensitive, it may also pick up things that are not cancers but cannot be ruled out without biopsy. Therefore, there is the chance for more biopsies with this surveillance regimen. I then follow the high-risk patient at least once a year, sometimes more often if needed.
Another important part of your initial visit will be a genetic risk assessment to look at family history. This requires much discussion in and of itself. We’ll take a close look at this topic in a future blog.
About Kathleen Jeffery, M.D.
Dr. Jeffery comes to St. Mary's from Greenwood, S.C., where she served as medical director of the Breast Center at Self Regional Healthcare and as a partner in Advanced Surgical Associates. Previously, she practiced with Summit Surgical in Dahlonega, Ga., and was an assistant professor of surgery with the Medical College of Georgia in Augusta.
Dr. Jeffery is now accepting patient appointments. A referral from a primary care physician may be required under some insurance plans. As part of St. Mary's Medical Group, AGCS accepts most major insurance plans and Medicare. Please contact your insurance provider for more information regarding your specific plan requirements for a specialist referral.