High Risk Consultations

Many factors play a role in determining a women's risk of developing breast cancer. Risk assessment tools are used to determine risk, and, ultimately to develop personalized screening programs. Are you at high risk?

What is high risk?

Risk factors for the development of breast cancer include age, parity (full term pregnancies), family history, and, a variety of ‘high risk lesions’ found at biopsy. Some patients, whose risks are significant can/should be followed under a high risk protocol, overseen by a High Risk Program. Comprehensive Breast Care has such a program. This program allows patients risk to undergo assessment and the appropriate screening modalities (mammogram, MRI, ultrasound, screening breast ultrasound (ABUS), genetic conseling & testing) are coordinated.

Risk Assessment

There are multiple methods to assess the risk for the future development of breast cancer.  Multiple statistical models have been developed to estimate a women’s risk.  Breast density also has a role in determining risk.  Combining all risk factors to determine a persons risk of developing breast cancer is more complex than ever.  Risk is generally presented as the risk to develop breast cancer within 5 years and in one’s lifetime.  These risk values are then used to determine the need for additional testing beyond mammography (such as screenig MRI) and/or chemoprevention (medications used to reduce risk).

Some models are better than others depending on the situation.  Many insurance companies require specific evaluations of ‘risk’ prior to authorizing certain tests like breast MRI.  Understanding which assessment tool is vital to obtain the proper testing and justifying the test to the insurance companies.  It is not a ‘one size fits all’ scenario.

Risk Reduction

Chemoprevention

Chemoprevention trials in the US and Europe have evaluated selective estrogen receptor modulators to prevent breast cancer in high risk women.  The Breast Cancer Prevention Trial demonstrated that Tamoxifen produced a 49% reduction in invasive breast cancer in US women at increased risk.  The Multiple Outcomes Raloxifene Evaluation trial for osteoporosis and the Raloxifene Use of the Heart trial both demonstrated a substantial reduction in the risk of breast cancer in post-menopausal women.  Both of these medications are considered effective as risk reducing strategies in high risk women.  As with most effective treatments, there are side effects that need to be considered (eg. risk of endometrial cancer, stroke, heart disease, cataracts and bone loss).  The table below (J Clin Oncol 29:2327-2333) provides clinicians a very nice tool to evaluate the risks and benefits of treatment.  Proper counseling is essential to this important decision, in the face of high risk.

Tamoxifen benefit