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High Risk Breast Program

What does it mean to be at high risk for breast cancer? 

Women at average risk for breast cancer have a 12% lifetime risk of developing breast cancer. However, some women are at a higher risk of developing breast cancer. The American Cancer Society defines high risk as having greater than 21-25% lifetime risk of developing breast cancer. The degree of risk is based on assessing risk factors using guidelines set by the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO). Once qualified as potentially being at high risk, a risk assessment is performed to identify the risk level. Women at high risk for developing breast cancer may have a genetic predisposition for developing breast cancer known as Hereditary Breast and Ovarian Syndrome.

Women with the BRCA1 and BRCA2 genetic mutations not only have up to 85% risk of developing breast cancer and 45% risk of developing ovarian cancer in their lifetime but also are at increased risk of developing other forms of cancer 

What is Hereditary Breast and Ovarian Syndrome?

5-10 % of breast and ovarian cancers are caused by genetic predisposition. Mutations involving the BRCA 1 and BRCA 2 genes are responsible for the majority of these cancers. BRCA 1 and BRCA 2 genes represent tumor suppressor genes. Normally, these genes function to help suppress cancers that are arising. However, once altered, these genes are not as capable of suppressing cancers and therefore, carriers of mutations within these genes are at a higher risk of developing certain cancers including breast and ovarian cancer. 


Early identification of high risk patients is the key to management

For women at a higher risk of developing breast cancer, early identification is the key to management. Once detected early, different management pathways can be considered. These pathways may include cancer prevention regimens, various screening methods and possible surgical planning. Cancer prevention and early detection reduces mortality. 

3.3 – 5.9 % of the mammography population (without a history of cancer) fall into the high risk category and warrant further testing and 20.6% of women diagnosed with breast cancer are in the high risk category and warrant further testing

What are possible risk factors that you should be aware of?

  • Close relative who tested positive for BRCA
  • Early onset of breast cancer (before the age of 50)
  • More than one occurrence of breast cancer
  • Personal or family history of ovarian cancer
  • One or more close relatives with breast cancer (especially before age 50) and/or ovarian cancer.
  • Ashkenazi (Central or Eastern European) Jewish heritage and family or personal history of breast cancer
  • Breast cancer that appeared in both breasts
  • Breast cancer in a male relative
Other Factors That Elevate Risk:

It is important to keep in mind that other factors can also elevate risk. All of these factors need to be taken into consideration when developing your individualized breast health plan.

  • Radiation to the chest between 10 – 30 years of age: High risk
  • Dense breast tissue: Intermediate risk
  • ADH (Atypical Ductal Hyperplasia), LCIS (Lobular Carcinoma In Situ): Intermediate risk 
  • Other rare genetic mutations
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