High Risk Patients and Breast Cancer Management
High Risk Patients
If you are at high risk for breast cancer, your preventative care will differ than an individual who is not considered high risk. The definition of high risk for breast cancer includes a presence of one or a combination of the following factors:
- Breast cancer occurring in the individual/family before the age of 50
- 2 or more breast cancers occurring in the family, one under 50
- 3 or more breast cancer occurring on the same side of the family at any age
- Ovarian cancer occurring in the individual/ family at any age
- Male breast occurring in the individual/ family at any age
- Presence of a BRCA1 or BRCA2, p53, PTEN mutation in the individual or if individual is untested and extended family member is known to have mutation.
- Breast – biopsy proven atypical ductal hyperplasia, or atypical lobular hyperplasia, or lobular carcinoma insitu (LCIS)
- Prior radiation therapy to thoracic area
High Risk Consultation visit:
- Perform risk evaluation using appropriate breast cancer risk tool (IBIS/Cuzick, Hughes App)
- Extensive family history of all cancers
- Perform clinical breast exam
- Genetic evaluation & testing if appropriate
- Patient will be taught self breast exam (SBE)
In general, high risk patients should be seen every 6 months for CBE and/or imaging. Sometimes these exams are split between primary care and Omaha Surgical Consultants. Patients with presence of BrCA and other mutation carriers should be monitored yearly with breast MRI.
Possible Risk Reduction Interventions:
- Risk reduction bilateral mastectomy with or without reconstruction (usually considered with women with known BRAC or other predisposing gene mutation, LCIS).
- Risk reduction oophorectomy(with mutation carriers)
- Risk reduction agent- Tamoxifen/ Raloxifen
There are different types of breast cancer, and different treatments that can work for each. If you’ve been diagnosed with breast cancer, Omaha Surgical Consultants can help you understand what type you have and what treatments would be best for you.
To learn about your type of breast cancer and to help you make the best treatment decisions, your doctor will look at three important things:
- 1. how you’re feeling and changes you notice about your body
- 2. what is found on your physical exam, and
- 3. results of your radiology tests and pathology reports
Fragmented care is a great difficulty facing breast cancer patients. Care includes radiologists, oncologists, pathologists, surgeons and so on. Omaha Surgical Consultants’ expertise is at helping individuals manage and coordinate care across all the medical disciplines involved in your treatment plan.
Should it be deemed best for an individual to undergo surgical intervention, Omaha Surgical Consultants can provide the following services:
- Surgical consultation regarding a new breast cancer
- Surgical consultation on a high risk breast lesion such as atypical ductal or lobular hyperplasia
- Partial Mastectomies
- Sentinel lymph node biopsy
- Axillary node dissection
- Infusaport placement