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Women have more information about their breast cancer risk than past generations ever had. And if a woman is identified as high risk, she has more options for prevention.
Some women at the highest level of risk, such as those with a dangerous BRCA1 or BRCA2 gene mutation, may feel their choice of options is relatively clear-cut. This type of mutation and a strong family history of cancer led actress Angelina Jolie to famously opt for a double mastectomy and removal of her ovaries and fallopian tubes. For some women at moderate risk levels, however, the decision between preventative surgery and increased surveillance can be emotionally overwhelming.
A breast cancer risk assessment program, like the one at Edward Hospital, can help a woman determine and understand her risk, and, if necessary, decide what course of prevention and/or surveillance to take.
While a nurse navigator guides each patient through the assessment, I work closely with a genetic counselor to explore in detail any possible risk factors for the patient, especially relevant family history. In some cases, we recommend genetic testing to determine if concerning gene mutations are present. Testing has expanded beyond that for BRCA1 and BRCA2.
The assessment may result in a plan that includes: medication for breast cancer prevention, more frequent mammograms and/or other imaging tests, such as MRIs, and surgical intervention for those at highest risk.
In addition, a multidisciplinary panel of cancer experts — including medical, surgical and radiation oncologists, genetics experts, pathologists, and others — routinely discusses each high-risk patient from diagnosis through follow-up, and helps develop a personalized treatment plan. Published studies show this type of care results in better outcomes.
The options presented to a patient shouldn’t be based solely on percentages. Every patient is unique, and it’s important to take into account individual emotional experiences and quality of life issues.
Ultimately, these are very personal decisions each woman faces; and each woman should have the information and support she needs to understand her risk and make informed decisions.
Samir Undevia, MD, is a medical oncologist and director of the Edward Cancer Center Breast Cancer Risk Assessment Program.
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