Ask the Expert: High-Risk Breast Cancer Patients

The Baptist Women’s Health Center now offers the Benign Risk Management Center to identify women who are at high risk for developing breast cancer; help find follow-up care for breast cancer patients; and assist women who find a lump and need to get a mammogram quickly, but may not have insurance coverage or other means to pay for their mammogram. Marcia Kirby, a nurse practitioner at the Women’s Health Center, is this month’s Ask the Expert on high-risk breast cancer patients.

[toggle title=”What is the importance of breast health for women?” state=”open”]We’ve known for years that early detection of breast cancer improves a woman’s survival. We work to educate women about breast health, breast self-exams, the importance of mammograms and finding out about their family history to determine their risk.
[/toggle] [toggle title=”How soon should women determine their risk for breast cancer?” state=”close”]Women in their 20s should find out about their family history. A woman’s family history may affect her risk of developing breast cancer as well as other diseases. Family history helps discover not only one’s risk, but it can also help health care professionals plan appropriate care based on that risk.

[/toggle] [toggle title=”What factors determine a woman’s risk for developing breast cancer?” state=”close”]

There are several factors that help determine risk for developing breast cancer, including the age a woman began menstruating, how old she was when she had her first child, the age when she began menopause, if she has ever had breast biopsies, and if any relatives on her mother’s or father’s side had cancer. Computerized risk models can give us a baseline of the patient’s risk of developing breast cancer in the next five years and in her lifetime.

The models allow us to also determine if the patient would benefit from genetic counseling and/or testing. The most common tests look for abnormal genes, such as BRCA-1 and BRCA-2.

Only about 5 to 10 percent of breast cancers are related to an abnormal gene. However, if a patient does carry one of these abnormal genes, she has a 40-85 percent chance of developing breast cancer and a 16-60 percent chance of developing ovarian cancer in her lifetime.
[/toggle] [toggle title=”Who is most likely to develop breast cancer?” state=”close”] A woman is most likely to develop breast cancer if:

  • At least two close relatives developed breast cancer before menopause
  • She has a family history of ovarian cancer
  • She has a male relative with breast cancer
  • She has a family member with breast and ovarian cancer
  • She has a family member with breast cancer in both breasts
  • She has a family member who tested positive for the BRCA-1 or BRCA-2 gene
  • She is of Ashkenazi (eastern European) Jewish ancestry and has a close relative with breast or ovarian cancer
[/toggle] [toggle title=”What can women do to prevent breast cancer?” state=”close”] Maintaining a normal body weight and body mass index; exercising 30 minutes a day, 5 days a week; and limiting alcohol intake to two or fewer drinks a week can help reduce the risk of developing breast cancer.
[/toggle] [toggle title=”How do you help women reduce their risk once they are deemed “high-risk”?” state=”close”] We follow the patient and offer alternating mammograms and MRIs every six months. Additionally, we can prescribe anti-estrogen therapy, which blocks the estrogen receptors in the breast and can cut a woman’s risk of developing breast cancer in half. In women who have an abnormal gene, such as BRCA-1 or BRCA-2, getting a mastectomy before breast cancer develops is also an option.

[/toggle] [toggle title=”How are women without proper insurance coverage able to receive help?” state=”close”] Several charitable organizations offer grants for those who are uninsured or have limited resources. We are able to help these patients find that funding and get mammograms.

[/toggle] [toggle title=”What is the most important thing for women to do regarding breast health?” state=”close”] Besides a self-breast exam, women should also have a clinical breast exam by a physician, nurse practitioner or physician assistant at least once a year.

[/toggle] [toggle title=”Anything else?” state=”close”] Here are a few more tips:

  • Learn your family medical history on your mother’s and father’s sides.
  • Become familiar with the normal look and texture of your breasts by performing monthly breast self-exams.  The best time to check your breasts is five to seven days after the beginning of your menstrual cycle.
  • If you find a change or something new in your breasts such as a lump, spontaneous nipple discharge or retraction, redness or swelling, see your primary care physician for evaluation.