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Essentia Health offers high-risk breast cancer program: Program identifies women, provides education and develops care plan

Dr. Aby Philip of Essentia Health-St. Joseph's Medical Center

The earlier breast cancer is detected, the better a woman's chances are at surviving the disease.

Essentia Health recently began offering a high-risk breast cancer program at Essentia Health-St. Joseph's Medical Center in Brainerd.

"It's to identify women who are at a higher risk of breast cancer than the average woman in the United States," said Dr. Aby Philip, chair of hematology/oncology at Essentia Health-St. Joseph's Medical Center.

The program specifically focuses on the individual's risk for developing breast cancer and how best to intervene to monitor for breast cancer and reduce their risk.

"They could be at a higher risk because of their family history or because they had exposure to radiation as a child. Some people go through cancer treatment as children and then sometimes it puts them at higher risk for cancers later on," he said. "Or they could have a genetic mutation that was passed on from their parents."

Breast cancer occurrence

Breast cancer is the most common cancer in American women, except for skin cancers. According to the American Cancer Society, the average risk of a woman in the United States developing breast cancer sometime in her life is about 12%.

"Anybody who has a 20% or more risk of getting breast cancer during their lifetime is deemed high risk," Philip said.

Patients and the nurse practitioner partner to form a personalized plan of care in an effort to reduce the risk for breast cancer, and provide the patient and their primary care provider with the most appropriate surveillance measures to screen for breast cancer.

"Sometimes we do increased screenings like, for example, if somebody is a very high risk, then we may do mammograms once a year and MRIs once a year, alternating every six months, so they'll have two tests, every year, screening tests to diagnose cancer early," Philip said.

A comprehensive evaluation includes discussion about the woman's personal and family medical history, which is utilized to calculate and determine the individual's risk for developing breast cancer, followed by education and counseling provided as part of the program.

This year, about 268,600 new cases of invasive breast cancer will be diagnosed in women, according to estimates by the American Cancer Society, and about 41,760 women will die from breast cancer.

"Some women who are very high risk, like if they carry a BRCA mutation ... there are some interventions that we can do to prevent them from developing breast cancer. For example, prophylactic bilateral mastectomy ... both breasts removed, so they don't get cancer," he said.

"Or we can put them on anti-estrogen pills for about five years. That helps to decrease the risk of them developing breast cancer, so there are some interventions that we can do."

A BRCA mutation is a mutation in the BRCA1 or BRCA2 genes, which are tumor-suppressing genes. Women with those harmful mutations have a risk of breast cancer that is about five times the normal risk, according to the National Cancer Institute.

Oscar-winner Angelina Jolie discovered through genetic testing she was at high risk for breast cancer and underwent a prophylactic bilateral mastectomy to reduce her risk of developing the disease, as did actress Christina Applegate, who inherited a BRCA1 mutation.

"There are other factors involved like, for example, have they had breast biopsies in the past ... when did they start having their menstrual periods or, if they are older, when did they stop—in other words, what was the exposure to estrogen during her lifetime," Philip said of risk factors.

Mortality rates from breast cancer dropped 40% from 1989 to 2016, according to the American Cancer Society, and breast cancer death rates have been steady in women younger than 50 since 2007, but have continued to decrease in older women.

These decreases are believed to be the result of finding breast cancer earlier through screening and increased awareness, as well as better treatments, according to the American Cancer Society.

"Family history is very important, especially if it's a first-degree relative—parent, brother or sister," Philip said. "Two or more first-degree relatives with breast cancer, especially with breast cancer at less than 50 years of age, could indicate a family predisposition to developing breast cancer."

Annual mammograms

According to the American Cancer Society, there are more than 3.1 million breast cancer survivors in the United States, including women still being treated and those who have completed treatment.

"We also educate women on lifestyle changes. There are things like obesity, which increases the risk of cancer because obese women have higher exposure to estrogen, so we can counsel them on lifestyle changes like losing weight, low consumption of alcohol," Philip said. "From a patient perspective, we want to catch these things early, and so from that perspective, I think it's best for patients to have a mammogram done every year. ...

"In my opinion, I see young breast cancer here, and in my opinion, that's a small price to pay to catching this early."

The most common symptom of breast cancer is a new lump or mass, but other symptoms are also possible, according to the American Cancer Society, so it is important to have any breast change checked by a health care provider.

"Because of the increased screening, we are catching a lot of the breast cancer, and the good thing is we're catching them early, so we can cure a lot of them," Philip said. "And also if you catch them early, they probably may not even need chemotherapy. They would just need surgery and maybe radiation and some anti-estrogen, and that would take care of it. ... It used to be that we were catching them in the later stages."

Essentia Health recommends annual mammograms beginning at age 40. The potential risks and benefits from screening after age 75 have not been thoroughly investigated, but this population is at risk for developing breast cancer and may benefit from continued screening.

"Anything that we can do to reduce one's risk and optimize surveillance measures for breast cancer is in everyone's best interest," Philip said.

To make an appointment, a woman should meet with her primary care or OB-GYN provider, who can place a referral to the Essentia Health program on a woman's behalf.

Essentia's high-risk breast cancer program is for ...

• Women who have: several close relatives on the same side of the family with breast cancer; a mother, sister or daughter with breast cancer at age 50 or less; two first-degree relatives (mother, sister or daughter) with breast cancer at any age; or a close male relative with breast cancer at any age.

• If a woman or her close family member have an abnormal gene that increases the risk of breast cancer.

• If a woman has had radiation treatments to the chest area under the age of 30 for Hodgkin disease or lymphoma.

• Women who took DES (diethylstilbestrol) in the 1940s to 1960s to prevent miscarriage.

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