Managing Elevated Breast Cancer Risk: Now What?
If you are identified as being at increased risk for breast cancer due to personal or family history, you will have the opportunity to meet with a genetic counselor to discuss whether genetic testing is the right option for you. The counselor will review the following with you:
- Use and appropriateness of genetic testing
- Medical and psychosocial implications of genetic testing
- Chances that your family members may also carry a mutation that increases their risk for cancer
Genetic testing requires a DNA sample, typically obtained through blood or saliva. When the results of your genetic testing are ready, your genetic counselor will meet with you to discuss the implications for you and your family. Learn more about genetic testing and the Genomic Medicine Institute at El Camino Hospital.
Specific risk management is often recommended for women with a BRCA1 or BRCA2 genetic mutation. Each patient receives specific recommendations based on age, health, heredity, and other factors. A team of specialists - including a medical oncologist, surgeon, radiologist, and other experts - collaborates on every plan. Each expert meets individually with the patient and the nurse navigator to develop an individualized care plan and discuss a patient’s options, which may include some or all of the following measures:
Surveillance for early detection. In addition to yearly mammography, further testing may be prescribed, including breast MRI, more detailed mammography, more frequent clinical exams, and transvaginal ultrasound and CA-125, a blood test for ovarian cancer.
Chemoprevention. Also known as chemoprochylaxis, chemoprevention means taking medication to decrease the chances of developing breast cancer. Our specialists may prescribe a variety of different medications, which are typically used to reduce the effect of estrogen on the body.
Preventative Surgery is the surgical removal of both breasts. This is a difficult and highly personal decision, and women who make this choice often have lost a loved one to breast cancer and are familiar with the toll cancer takes on families. Preventative surgery may involve removal of all breast tissue (mastectomy) and removal of the tubes and ovaries (salpingo-oophorectomy). This cuts the risk of breast cancer in high-risk premenopausal women by 50 percent and reduces the risk of ovarian cancer by greater than 90 percent. Our expert breast and plastic surgeons offer multiple reconstructive options for immediate reconstruction, if desired.
Lifestyle Changes. Weight loss, regular exercise, and a reduction in alcohol consumption can help reduce breast cancer risk and improve general wellness. The High-Risk Breast Program has a dietitian on staff to provide advice about diet and proper nutrition. The program also collaborates with local health clubs to promote fitness programs for women at risk.
Automated 3D Ultrasound for Dense Breasts
Dense breasts are an independent risk factor for breast cancer, regardless of whether a woman is also at risk genetically. Breasts are composed of fat and milk-producing fibroglandular tissue. The density of breast tissue is typically split into two categories: dense or fatty. "Dense breasts" have a high percentage of fibroglandular tissue, while "fatty" breasts have a lower percentage. Breast density makes regular mammograms especially challenging to read. At El Camino Hospital, we utilize a computer algorithm that automatically and objectively determines the volumetric density of each woman’s breast tissue from the information contained in her mammogram. If your breast tissue density is high, it may be appropriate for you to have a breast screening ultrasound examination or a breast MRI.
Mammography is still the first line of defense in breast cancer screening, but adding one of these other technologies can substantially improve cancer detection in women with high breast tissue density. The Breast Health Center at our Mountain View campus has acquired a sophisticated new technology known as automated breast ultrasound (ABUS™). As the only hospital in Northern California to offer this technology, we use ABUS™ to supplement routine mammography and help locate tiny tumors that may be hidden in dense tissue. Learn more by viewing the video from our Breast Health: Innovations and Advancements lecture.