High Risk Genetic Testing/Counseling
Our High Risk Breast Program is a multi-disciplinary program designed to identify, counsel, and manage women at high risk for breast cancer. Current research shows there are risk factors that may influence the development of breast cancer. Identifying people with these risk factors and implementing closer surveillance and risk reduction techniques may detect cancer earlier. Early detection of breast cancer leads to better prognosis and outcomes.
Some of the risk factors for breast cancer are:
- Sex: The overwhelming majority of breast cancers occur in women.
- Age: As a woman gets older her risk of breast cancer increases.
- Race: Caucasian women have the highest incidence of breast cancer.
- Personal History of Breast or Ovarian Cancer
- Atypical Cells on a breast biopsy
- Family History of breast or ovarian cancer
- Breast Density
- Not having children or having a first child over 30.
- Radiation Exposure
The High Risk Breast Program is multi-disciplinary and has collaborative relationships with Surgery, Medical Oncology, Gynecology Oncology, Plastic Surgery, Nutrition, Behavioral Medicine, and Nursing.
Our program offers a variety of services, such as:
- Personalized risk assessment based on personal risk factors as well as family history
- Personalized surveillance program based on individual risk factors
- Counseling on methods to reduce your risk of breast cancer
- Clinical Breast Exam
- Genetic counseling
- Referral for diagnostic procedures such as Mammogram, Ultrasound, MRI, and?core needle biopsy
- Referrals to appropriate services such as behavioral medicine, nutrition, gynecology, and plastic surgery
- Access to Breast Cancer prevention clinical trials
The overwhelming majority of breast cancers occur in women. While it does also occur in men, the ratio of women to men is 135:1.
As a woman gets older her risk of breast cancer increases. For example, at age 30, 1 in 2200 women develop breast cancer but at age 80 approximately 1 in 10 develop breast cancer.
Caucasian women have the highest incidence of breast cancer.
Personal History of Breast or Ovarian Cancer
Women who have had a breast cancer in one breast have a higher risk of developing another breast cancer; either within the same breast or in the other. Women who have had ovarian cancer are also at a higher risk of developing breast cancer.
Women who have had a breast biopsy with atypical hyperplasia (ductal or lobular), lobular carcinoma in situ, or cellular atypia also have an elevated risk for the development of breast cancer.
Having a strong family history of breast cancer (either maternal or paternal) increases a woman's risk status.
Breast density tends to decrease as a woman ages. As she gets older the dense ducts and lobules (glandular tissue) get replaced by fatty tissue. High breast density, especially post-menopausally, is a risk factor for breast cancer.
The longer the breasts have been exposed to hormones, the higher the risk for developing breast cancer. Therefore, women who started menstruating before the age of 12 and stopped menstruating after 55 are at greater risk.
Not having children or having a first child over 30 also increases a woman's risk. Breast-feeding has been shown to reduce breast cancer risk.
Prior radiation to the chest area, especially during the period between puberty and 30 years of age, increases the risk of breast cancer.
Studies suggest that greater than 2 drinks a day increases breast cancer risk.
Hereditary Breast Cancer
5-10% of all the breast cancers we see are likely due to an inherited mutation. BRCA 1 and BRCA 2 are two genes everyone has. Certain people are born with a mutation of one of these genes and this mutation significantly increases their likelihood of developing breast and ovarian cancer. Some red flags in a person's personal or family history that would make us concerned about a genetic mutation are:
- Breast cancer before the age of 50
- Ovarian cancer at any age
- Male breast cancer
- Bilateral breast cancer
- Both breast and ovarian cancer
- Relative with a BRCA 1 and BRCA 2 Mutation
To discuss your specific risk factors for breast cancer, call 1-866-246-4673 and ask for our Health High Risk Breast Clinic.
Breast cancer risk reduction can be managed in four different categories:
Some women who are found to be high risk may choose to have closer surveillance. Traditionally for average risk women guidelines for surveillance are:
- Monthly Self Breast Exam starting at age 18
- Clinical Breast Exam semiannually starting at age 25
- Annual mammograms at age 40 or 5-10 years younger than any 1st degree
- No specific guidelines for breast MRI
New guidelines for very high risk women or women with a known genetic mutation are:
- Monthly Breast Self Exam starting at age 18
- Clinical Breast Exam semiannually starting at age 25
- Annual mammograms alternating with breast MRI starting at the age of 25
The St. John Health High Risk Breast Clinic can help develop a personalized surveillance program for you based on your risk factors for breast cancer. For your personalized surveillance program, call 1-888-440-0644.
For extremely high risk women and women with known genetic mutations there are guidelines for increased ovarian surveillance. They are:
- Concurrent transvaginal ultrasound and CA-125 (blood test) every 6 months starting at age 35 or 5-10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family.
Diet: Some research suggests that diets low in fats may decrease your risk of breast cancer. We recommend avoiding diets high in saturated or hydrogenated fats such as peanut and vegetable oil and instead using fats such as canola or olive oil. We also recommend a diet rich in fresh fruits and vegetables which add cancer fighting anti-oxidants.
Weight: Some research suggests that postmenopausal obesity is a risk factor for breast cancer. Maintaining a healthy weight and exercising regularly may reduce your risk of breast cancer and improve your general health.
Alcohol: Consuming more than 2 drinks of alcohol a day does increase the risk of breast cancer. Recent data suggests that dietary folate can counteract the effect of alcohol.
Tamoxifen: Tamoxifen is a drug that is approved for breast cancer reduction in high-risk women. It is a selective estrogen receptor modulator; this means it works by blocking the effects of estrogen in breast tissue, which can be a stimulant for breast cancer cell growth. It has been shown to reduce breast cancer risk by 50%.
Oral Contraceptives: Oral contraceptives may reduce the risk of ovarian cancer in women with BRCA1 or BRCA2 mutations by as much as 54%.
Preventative Mastectomy: Preventative Mastectomy is the removal of both breasts. Preventative Mastectomy significantly reduces the risk of breast cancer to the high 90% range.
Preventative Oopherectomy: Preventative Oopherectomy is the removal of the ovaries for risk reduction. This procedure significantly reduces the risk of ovarian cancer by as much as 96% and the risk of breast cancer by as much as 53%.
For more information about ways you can reduce your risk call the High Risk Breast Clinic 1-888-440-0644.