Identifying Risk
By Tiffany Schmidt
In the United States alone, one in eight women will develop breast cancer through the course of their lifetime. It is the number one cause of cancer in women, and while lung cancer is the leading cause of death due to cancer in women, breast cancer is expected to overtake that number within the next 10 years.
To help change these statistics, Terry Elwing, MD, director of the Harris Breast Center, and Anne Petersen, MD, are leading the charge by formalizing the screening process at the High Risk Breast Clinic.
The Harris Breast Center has been providing women with breast health services at high-volume for years. The High Risk Breast Clinic takes the work a step further, seeking to identify patients and families with elevated risks of developing breast cancer.
The High Risk Breast Clinic is run by Dr. Petersen, along with Nurse Practitioner Tonya Linthacum. The clinic provides patients with an in-depth assessment of their lifetime risk of developing breast cancer. The clinic runs six different statistical models that are designed to compare the population risk for developing breast cancer. The information is recorded with state-of-the-art technology and stored in a database for comparison.
Advancing age, dense breast tissue, and hormonal factors, such as late pregnancy, are general risk factors; however, a family history of breast or ovarian cancers can often be one of the most telling indications of a high-risk patient.
Starting at age 40, every woman should get an annual mammogram. “Hopefully we can identify families, so that we can find the patients in their 20s or 30s who may need to be screened earlier than your standard patient in their 40s,” says Dr. Elwing. A patient who qualifies as “high-risk” determines whether additional imaging, such as an MRI, will be recommended.
“The average person has a 12% chance of developing breast cancer throughout their lifetime, while a high-risk patient has anywhere from 20% to 60% chance,” says Dr. Elwing. A patient’s score will be determined based on their responses during their consultation. Those who fall into the high-risk category may need additional genetic testing, or we may offer medications to decrease risk.
Lifestyle is another main focus at the clinic. Exposures to certain foods or hormones, diet, weight, or alcohol intake can all affect a person’s risk of developing breast cancer. “We discuss changes that a patient can make to reduce the risk of cancer,” says Dr. Petersen. “Sometimes, these outside influences have a greater impact on developing breast cancer than those that we carry inside our body.”
Once the genetic assessment is complete, the clinic then works on an individual basis with each patient to help create a plan for diet and exercise or preventative testing options. The clinic also works with patients to navigate insurance and payment costs that work for their care plan.
“We are here to partner with women to see what works for them,” says Dr. Petersen. “All of these things are just the beginning of a conversation and a starting point for how women can help to improve their health.”
Early Detection
For Cynthia Chick, it was of no surprise to hear that she was a high-risk patient. Female cancers had long plagued her family, with her mother beating breast cancer twice, and multiple cousins and aunts who were diagnosed with ovarian or uterine cancers.
Given her history, Cynthia had her first mammogram at age 30, but wasn’t considered a high-risk patient until after her daughter was born. Because of her high-risk status, Cynthia would complete an MRI each year with a follow-up exam shortly after.
With female cancers almost normalized within her family, Cynthia was admittedly bad about remembering and making appointments. “I had actually forgotten about my MRI, and the clinic called to check in and immediately rescheduled,” says Cynthia. “December 4 was the day I found out. That day, I’ll never forget.”
“The goal of screening is to catch the cancer early, and while it’s still curable,” Dr. Elwing explains. In Cynthia’s case, early detection gave her the ability to choose from two treatment options: a lumpectomy or double mastectomy with reconstruction.
With the lumpectomy, Cynthia would be able to keep her breasts, but would be required to complete both chemotherapy and radiation treatments, while the double mastectomy would remove both of her breasts, yet would greatly reduce her potential for future cancer.
“Dr. Petersen was very straightforward and informative about what to expect and what my options were,” says Cynthia. Due to her family history, they agreed that a double mastectomy was the most proactive route. Concerned about the potential for aggressive growth, Dr. Petersen quickly scheduled a double mastectomy for January 2019.
The cancer was about 7 millimeters when it was originally found. Once in surgery, it was discovered that the tumor was much larger than expected. After the surgery, chemotherapy was added to her treatment plan to help combat any remaining cancerous cells. “I think I cried harder when I started to lose my hair than I did when I found out I had cancer,” Cynthia says.
The treatment and recovery process is a tumultuous journey that has taken Cynthia from one end of the emotional spectrum to the other, “I’ve cried, I’ve been angry,” she explains, “Most days I’m okay with it — I know they found it early before my lymph nodes were affected and before it was too advanced.”
Cynthia’s tumor sat on the chest wall, making it nearly impossible to detect through self-examination, and wouldn’t have been found through a mammogram. Without the MRI, the cancer may have gone undetected for quite some time.
Cynthia is currently completing reconstruction. Looking back to the start of her journey less than a year ago, “I’d tell myself just to be patient — you will come through it,” Cynthia says. “There were some days after my mastectomy where I thought I’d never be able to pick up my arm again,” she adds. “Also, this too shall pass — mine passed like a kidney stone, but it passed.”
Preventative Treatment
The knowledge of your genetic makeup is a powerful tool, but for some, it may feel like a double-edged sword. As a young mother and former professional dancer, Amanda Helen was aware of her family history, but didn’t feel a strong urge to complete genetic testing due to her age and healthy lifestyle.
“I just thought, ‘What would I do with that information?’” she says. Upon being diagnosed with breast cancer, Amanda’s mother had tested positive for the BRCA2 gene, meaning there was a 50% chance that Amanda, too, would be positive. While not all individuals with a BRCA2 mutation develop breast cancer, those who are positive are at a much higher risk.
Though she didn’t get the genetic testing done, Amanda tried to stay proactive by keeping an open dialogue with her physicians. After mentioning her family history during a gynecologist appointment, she was directed to the High Risk Breast Clinic, where she was screened for her standard risk factors and family history.
At the time of her appointment, Amanda was still breastfeeding her son, so Dr. Petersen suggested an MRI where the clinic noted a suspicious area in her breast. After a follow-up mammogram and biopsy, it was confirmed that she did, in fact, have some cancerous cells.
“You hear those words ‘breast cancer,’ and you automatically think the worst,” says Amanda. “Everyone was shocked because, at 36, you don’t think cancer happens to people that young.” At this time, she knew it was time to proceed with genetic testing, which confirmed that she was BRCA2 positive.
Luckily, due to the early diagnosis, the presence of the cancer had been caught before the cells had even formed a lump. Because of her confirmation of the BRCA2 gene, Dr. Petersen encouraged preemptive treatment. “In my case, it was a matter of when, not if,” says Amanda.
“There are times when a woman could qualify for a mastectomy with reconstruction as a way to prevent breast cancer,” says Dr. Petersen. As a former professional dancer, Amanda struggled most with the potential loss of physical activity and appearance. Since she fit the criteria in both physical health and genetic makeup, she worked with her doctors to create a treatment plan for a double mastectomy with immediate reconstruction.
As her team quickly mobilized in preparation for the surgery, Amanda received some unexpected news due to the appearance of high glucose levels during her routine blood work. “Not only did I get a breast cancer diagnosis, but I was also diagnosed with Type 1 diabetes,” she says. Without the bloodwork, her diabetes could have gone unchecked for years.
During the surgery, it was found that because the cancer cells had been identified so early, they had not spread to her lymph nodes; however, when they received the pathology report some days later, it was determined that she would need radiation to complete her treatment.
“Sometimes, I feel like I didn’t earn the ‘Survivor Card’ because my journey was comparatively easy — I was diagnosed, a month later, had surgery, then just the six weeks of radiation. But then I remember I did have a body part amputated,” Amanda laughs.
On September 16, 2019, less than a year after her cancerous cells were discovered, Amanda was officially able to refer to herself as cancer-free. Because she opted for the double mastectomy, she has little-to-no risk of another breast cancer diagnosis.
In addition to breast cancer, the BRCA2 gene also runs a higher risk for ovarian, skin, and pancreatic cancers. Amanda and her husband are currently meeting with doctors to discuss the options of a prophylactic hysterectomy.
“Looking back, I wish I had been a little more open to doing things a little more proactively,” Amanda says. “I’m now a huge proponent and advocate for checking yourself and knowing your family history. It can help you ask questions and be aware.”
Rapid Response
“From the start, it’s a very quick process; our radiologists are on-site, and we can usually provide the patients with their results the same day,” says Dr. Elwing. “It all happens very quickly and smoothly — it’s a team process.”
Cynthia and Amanda agree that their breast cancer journeys were successful largely in part to the early detection and treatment of their cancer. “If my story can help even one person get early diagnosis, then this all feels worth it,” says Amanda.
The key factor is time. “All breast cancer is treatable,” says Dr. Elwing. “Seeing our patients frequently allows us to catch the cancers when they are a stage that is still curable, which is the whole goal of the screenings.”