High Risk Breast Care Clinic
Though roughly one out of every eight women will develop breast cancer in her lifetime, every woman’s risk of developing breast cancer is different. Gundersen’s High Risk Breast Care Clinic can provide you with answers if you have some reason to believe that you have an increased risk for developing breast cancer.
What should I do about my increased risk?
The intent of this high risk clinic is to develop a plan to reduce the chance that you will ever have advanced breast cancer. We believe that the best plan is one that you and your care providers develop as a team—working together to develop a plan and putting that plan into action.
There are two approaches we use to address your increased risk for developing breast cancer: screening and prevention. The general approach of screening is to detect breast cancer at an early, treatable stage. Prevention—also known as risk reduction—is aimed at lowering the chances that breast cancer ever develops. Most women choose a plan that involves some combination of these approaches.
The purpose of screening for breast cancer is to try to detect breast cancer at its earliest, most curable stages. There are several recommendations we have to screen for breast cancer if you are at increased risk:
- Monthly breast self-examinations
- Clinical breast examinations by a care provider every six months
- Yearly screening mammograms
- Yearly screening breast MRI may be recommended in some cases. We will review the advantages (increased sensitivity) and disadvantages (decreased specificity, increased cost) of breast MRI compared to conventional breast cancer screening.
There are a number of ways to reduce your chances of developing breast cancer. Some of these are more effective than others. You do have some choices:
- Regular aerobic exercise at least three times per week for at least 15-20 minutes each session
- Maintain a healthy weight (BMI 18-25)
- Diet high in vegetables, fruits and whole grains, but low in saturated fats and red meats
- Limit alcohol consumption to one alcoholic beverage per day for a woman
- Stop smoking
Although we lack definitive proof at this time that a healthy lifestyle has a big impact on reducing the risk for breast cancer, we know that maintaining a healthy lifestyle has other health benefits, so we strongly encourage this. Other health benefits of a healthy lifestyle include lowered risk of heart disease, stroke, diabetes and, possibly, other cancers.
Medical risk reduction
Taking certain prescription medicines can reduce the risk for developing breast cancer. These medications include tamoxifen, raloxifene, exemestane and anastrozole. As with any medications, there are potential risks and side effects, but for some women this non-surgical way to reduce risk is desirable.
Bilateral Prophylactic Mastectomies
Having preventive breast surgery before breast cancer starts is the most effective way to reduce your risk. This is known as prophylactic or preventative mastectomy. This operation reduces the risk of developing breast cancer by greater than 90 percent. This is understandably a very difficult choice for most women. Your care providers will discuss this option with you. The discussion will include level of effectiveness of this operation in preventing breast cancer, but will also include risk of surgery and a discussion of womens’ feelings about the operation years after it is performed. If performed, many women also choose plastic surgery to reconstruct new breasts.
Bilateral Prophylactic Oophorectomies
Bilateral prophylactic or preventative oophorectomies involve the removal of both ovaries and fallopian tubes. Although this is often done to reduce the risk of ovarian cancer, it has also been proven to lower the risk for breast cancer in certain kinds of hereditary breast cancer—such as women with BRCA1 or 2 mutations. In fact, the impact on reducing the breast cancer risk can be fairly strong. Removing the ovaries before menopause in a woman at increased risk for developing breast cancer may reduce the breast cancer risk by as much as 50 to 70 percent. Because screening for ovarian cancer is not effective, prophylactic oophorectomies are usually recommended to reduce risk of ovarian cancer in women who have BRCA1/2 mutations. Your care providers will discuss the benefits and risks of this option with you.
If your increased risk for developing breast cancer comes primarily from a strong family history of breast or ovarian cancer, then the information that we share with you about increased risk is also important to share with other family members. Our cancer genetic counselor can help you figure out who in your family should be contacted and how best to share the information. If there is a hereditary cancer risk in your family, it is crucial that you share this with your family members. This will allow them to take charge of their healthcare—as you have.