Chapters Transcript Video Identification, Screening and Management of Women at High Risk of Breast Cancerr thank you so much for joining me for this discussion on the identification, screening and management of women at high risk for breast cancer. First and foremost, who is it? Increased risk for breast cancer? Let's talk about that a little bit. We all know patients that have a family history of breast cancer, whether they carry a gene that predisposes to breast cancer or not, are at increased risk for breast cancer. And then, of course, there many genetic predispositions that dramatically increase the risk of breast cancer and some that do so to a lesser degree. The most Siris of these would be the bracket gene, BRCA one and BRCA two, and that could result in up to an 85% increased risk for breast cancer. Any women within Ashkenazi Jewish heritage TP 53 p 10 or CHD one. Genetic defects are also at increased risk for breast cancer. Women who have a history of prior biopsies are also predisposed to breast cancer, especially if they reveal a tibia, LCS or a radio scar or some other additional lesions. Women who have a prolonged history of unopposed estrogen stimulation are also increased risk, and that can come from either early monarchy, late menopause or no interruptions for childbirth or breastfeeding. Eso women who are Nullah, Paris or who have geriatric pregnancies are at increased risk for breast cancer. Any woman with a history of radiation to the chest is also an increased risk, and dense breast tissue is also an independent risk factor for breast cancer. Minor risk factors are considered. Height. Ah, high socioeconomic status. De es exposure. Ah, late age of pregnancy that being greater than 30 years late menopause later than 55 years. Ah, personal history of endometrial or ovarian cancer and also breast density. Each of these factors are considered minor. Um, important question is, what might women do to decrease the risk of breast cancer? So what are the potentially modifiable risk factors for breast cancer? Alcohol consumption is certainly one of them. Alcohol. Isn't he considered a person a gin? And in the case of breast cancer, does increase the risk of breast cancer recurrence and probably also breast cancer. Obesity is correlated with a higher rate of breast cancer due to peripheral metabolism of estrogen, Diet can play a role recent or long term use of postmenopausal hormone replacement therapy is, ah, cause for increased risk for breast cancer. Nilla parody and also never having breast fed or having your first child later in life. So what can women do to decrease their risk? Regular exercise has been correlated with a lower incidence of breast cancer recurrence and probably would be for breast cancer risk. Overall elimination of hormone replacement therapy can decrease a woman's risk for hormone positive breast cancers. Maintenance of ideal body weight is important, as is limiting alcohol intake ideally completely or to less than one drink per day. Healthy diet is also important in terms of decreasing the risk of breast cancer. Uh, several studies document this fewer processed foods is better. A plant based diet is correlated with lower incidence of breast cancer and breast cancer recurrence. I like to tell patients to have a diet that's high in fruits and vegetables and very colorful. The dark blues, Dark greens, reds yellows are an important component of this broccoli itself, as a single vegetable has been shown to decrease the risk of breast cancer, and a Mediterranean diet in several studies independently has been shown to decrease the risk of breast cancer and several other cancers. Incidentally, what is the Mediterranean diet? It's more fish. Fewer meets extra virgin olive oil is an important component of it as our nuts, healthy fats, whole grains and legumes. It's also important to know when patients come in what doesn't increase the risk of breast cancer. So this risk this risk list. Below are some of those things that patients frequently will come in concerned about. And there is no preponderance of data that suggests that any of these things can lead to an increased risk of breast cancer, hair dyeing, hair relaxers, air something that come up. And while there are some studies that suggest that there may be a risk associated with that, it is not generally accepted yet likewise, deodorant and antiperspirants on DMA any of the other things listed there? Uh, breast implants is not correlated with increased risk of breast cancer, Um, nor our cell phones or trauma or migraines or left handedness. That list is pretty complete, so it's something to be aware of in case patients approach approach you with concerns about each of these things. There are a lot of ways to calculate the absolute risk of breast cancer that the most popular model is the Gail model, and this is readily available online on several websites and buy in putting a few variables. You can come up with a number that predicts a woman's risk of breast cancer so long as they haven't previously had breast cancer and are over the age of 30. Uh, there are several additional breast cancer risk models, including the Klaus Model, the Backup Pro Model and the Hughes Risk app, which includes all of the's. The tire Kuzzik model tends to over estimate a woman's risk of breast cancer and is a very comprehensive model. The links to each of those calculators is in the slide presentation, and for the huge risk app, you can create an account. And for the others, it's free to do these calculations and very helpful for the patients. Once you have this information, if a patient's risk is greater than 20% there are a lot of things that can actually be done. So calculating the risk is more than interesting is actually actionable, uh, weaken suggest enhanced screening. And that's including an Emory. In addition to an annual mammogram, we at Roswell will usually do the memorize staggered from the mammograms, so the breasts are being examined every six months. So, for instance, if a patient is having their mammograms every January, we would do their memories every July. That way, the breasts are being checked regularly and frequently in terms of doing something medically. In terms of the risk came a prevention is something that can be offered to patients, and we have to drug classes that could be used to decrease the risk of breast cancer. Two mocks often can be given that's 20 mg daily, and this definitely decreases the risk of press cancer by up to 50 to 55% for patients who are reluctant to take it. There are studies that suggest half dozing even every other day does have a beneficial effect over um, not giving the patient the medication. Aromatase inhibitors are also proven to decrease the risk of breast cancer by up to 60 to 65%. Dozing is included there. There are several different drugs within that family, and patients can be rotated from one to another drug class if they're having symptoms for patients with substantially increased risk of breast cancer, for instance, those that carry the BRCA gene consideration could be given to prophylactic mastectomies on a patient's threat showed, for that is going to vary from patient to patient. Patients, sometimes with a very low risk, will be very anxiety ridden and will insist on having prophylactic mastectomies. And so I'd like to spend a lot of time talking to patients about the available data and how much of the benefit they can expect to enjoy. The fact of the matter is there is no study that documents a survival advantage with prophylactic mastectomies. Although there's a decrease incidents of breast cancer that hasn't been correlated with overall survival advantage when done in the prophylactic setting, Any woman who opts for a prophylactic mastectomy should certainly be offered immediate reconstruction. And there are many ways to do that. Some women that carry a gene such as the bracket gene may have a very high risk of breast cancer and not to do nothing in terms of preventative surgery. And in those cases we like to be sure that they participate with chemo prevention and enhanced screening. That's very important. There are several national societies that have put out recommendations for breast cancer screening and women with average risk, and these are included below for most of them. Screening starts at 40 their additional protocols for screening women with various conditions that predispose them to press cancer and those air listed in great detail in the following screens. Other screening recommendations are available on the websites for the American Cancer Society and the U. S Preventive Service Task Force. Various special T societies, including the O, B, G, y n, as well as the pediatric societies, also have additional information about screening recommendations. Additional considerations related to screening include Emery On for pre menopausal women. The best timing for the emery is 7 to 15 days into their menstrual cycle. For postmenopausal women, Emery could be done at any time of the month for high risk patients that are getting both mammography and breast memory. We like to stagger those screenings. Emory does have enhanced ability to detect early breast cancer. However, there are also some drawbacks. For instance, memory will detect lesions that are sometimes not, actually, um, cancerous or precancerous, so unnecessary biopsies are done on patients. This can increase their anxiety and can result in having unnecessary biopsies. Also, Emery requires a special magnet as well as contrast. And for some patients, this presents a difficulty finding AH unit close to their home. Some patients cannot tolerate the contrast agent, and also not every insurance company will cover memory screening for patients, so there may be impediments in terms of insurance. What I would like you to remember for today is that while some patients are at increased risk for breast cancer for various reasons, that's actionable information and we can do something about it. There is genetic testing available. There are diagnostic tools, including mammograms, memories, ultrasounds that can help us to detect that and also risk calculating tools that can help determine what the exact risk is. And based on that information, we can do things to decrease the patient's risk and maximize the chances that we detect any breast cancers early, hopefully keeping your patients healthier. We do have a high risk screening clinic here at Roswell Park Comprehensive Cancer Center for your patients that may be an increased risk for breast cancer or who are known to be a risk for breast cancer. Kindly call us at 845 2300, and we will get them in to see one of our experts. Thank you Created by
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