Understanding and Managing Your Risk for Breast Cancer ... From Genetic Screening to Mammograms and More

While understanding and managing your own personal risk for breast cancer can be overwhelming, it's crucial for prevention and early detection. Studies highlight the importance of early detection in improving breast cancer treatment outcomes. This is why at Denver Health, we have chosen to focus our comprehensive breast care program on including a thorough risk assessment of each patient.
 

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Breast cancer risk involves a combination of factors including your personal history, family history, lifestyle choices and environmental factors. At your initial visit, we obtain your information and enter this into a risk calculator so that we can put a number on your risk. We then empower you with the knowledge and tools needed to manage your risk effectively. This year, Denver Health began using a genetic mapping software called Progeny, which contains eight validated risk assessment models to calculate a patient's cancer risk. We have combined this with genetic testing to give a complete picture of cancer risk and provide a foundation which we use to partner with you in determining the best plan of care.

 

Breast Cancer Risk: What's In Your Genes?

In 1994, it was first reported that there was a link between a mutation or change in the BRCA1 gene and breast and ovarian cancer. This was closely followed by the BRCA2 gene mutation identified in 1995. For years, only one lab in the country was testing for the presence of this "broken gene" which made it very unaffordable and therefore unobtainable for most people. I can vividly remember a patient getting a bill for $15,000 for genetic testing in 2011. While we got it reduced and covered, it was very stressful for all involved. Things are much different today.

In 2013, the supreme court ruled that isolated genes could not be patented which opened the door for other labs to also perform genetic testing. While this has made genetic testing more available and more affordable, it has also caused a lot of confusion. It is impossible to watch TV and not see an advertisement for direct-to-consumer genetic testing companies such as 23andMe. For many reasons, this is not the same as getting genetic testing ordered by a medical professional. A medical professional will determine if genetic testing is indicated, counsel you about what the findings may mean in terms of your future care and help you manage the results. It also has the added benefit of keeping your information private as a part of your health record. Fortunately, as of last July, we are now able to offer multi-gene testing here at Denver Health and it is often covered by insurance. 

Breast cancer genetic counseling and testing is now available to Denver Health patients with a referral from your primary care doctor. Begin by scheduling an appointment with your doctor to discuss whether it is right for you and then ask for a referral.

Options for Managing High Breast Cancer Risk

For those found to be a higher risk for breast cancer, Denver Health's high-risk program is designed to not only increase awareness but also to provide tailored information to patients and their families, promoting proactive health management. We meet with you and discuss both your genetic testing results and risk calculator score. Based on these results, here are some options available to lower your risk.

1. Enhanced surveillance. Enhanced surveillance for breast cancer consists of a yearly breast MRI and yearly mammogram sometimes supplemented by an ultrasound six months apart. The imaging is followed by a clinic visit also every six months for a breast exam, review of the imaging, updating the history and modifying the plan of care as needed.


2. Chemoprevention. In certain situations, there is a role for chemoprevention or endocrine therapy. These are tablets taken daily to provide a significant risk reduction for getting breast cancer. Like most medications, these have side effects which are also discussed and taken into consideration.


3. Preventive or Prophylactic Surgery. Having both breasts removed provides a 95% risk reduction of getting breast cancer in the future. Because a small amount of tissue must be left behind to keep the blood supply to the skin, this preventative surgery does not translate to zero risk. In instances where a patient does not have cancer, we can consider doing a cosmetic procedure first, which may be a breast reduction or breast lift in which the nipple would be spared. After allowing time for this to heal, we can then offer a nipple sparing mastectomy with immediate reconstruction. The reconstruction options consist of using an implant or using your own tissue which is called autologous. These procedures are done in partnership with Denver Health's talented plastic surgeons. Suffice to say, there is a lot of decision making involved and in a preventative situation, there is time to explore and consider these options. There is also time to use lifestyle modification methods to improve overall health which leads to better outcomes.  This includes getting the support needed to stop using tobacco products of any kind. Tobacco use causes narrowing of your small blood vessels and multiple problems with healing after surgery. We require that you have no tobacco in your system for a minimum of eight weeks before we will do any type of breast reconstruction. We welcome the opportunity to work with you and other medical professionals to support you in making these positive changes.


4. Lifestyle Modifications. There are many factors which we can't control which play a role in the risk of getting breast cancer. The good news is that adopting a healthy lifestyle is something which we can control and makes real differences not only in reducing cancer risk but also in reducing other health risks. One of the first things people ask is, "what shouldn't I eat?" The simple answer is to avoid processed foods and sugar as much as possible. I talk to people about choosing fruits and vegetables that are low or moderate on the glycemic index scale. This can also be a complex discussion, so we start with the basics and build on them over time. Along with this is limiting alcohol intake. Studies have shown that the risk of breast cancer increases with the amount of alcohol that is consumed. When these choices are managed well, this helps a patient achieve or maintain a healthy weight. Weight reduction also plays a role in decreasing our risk. There is an enzyme in fat cells which is called aromatase. This enzyme converts steroids produced by our adrenal gland to estrogen which cancer typically loves. If you think about it, all of these changes deprive cancer cells from what they need to grow and thrive.

 

What You Can Do Now to Reduce Your Breast Cancer Risk

The first thing I tell everyone that they can do is have conversations with family members who are willing to tell what they know about the history of cancer in the family. The more information, the better. In addition to the type of cancer, it is also helpful to learn about the age of the person, anything about their treatment and the outcomes. We take this into account when we are calculating your own risk. Next, gather information about your own history. With time, the details of the procedure, the pathology results, and recommendations that you have experienced fade over time. I tell patients to get a folder and keep a copy of their reports as it is often very useful later. Lastly, if you do not have a primary care provider, get established with one even if you have no current health issues. They are extremely knowledgeable about a wide variety of medical conditions and can give you up to date information for screening and lifestyle changes that you can adopt early.

As the Chief of Breast Surgical Oncology at Denver Health, Dr. Nancy Taft believes in compassionate and comprehensive care plans for her patients. Read more about her and learn more about Denver Health's comprehensive Breast Care Center.