A New Weapon in the War Against Breast Cancer

Knowing your risk for breast cancer can make all the difference.

The importance of a yearly mammogram.

Annual mammograms are the main tool doctors use to screen for breast cancer and diagnose, evaluate and follow up with those who’ve had breast cancer. Using non-invasive X-rays to examine the breast tissue, mammograms not only detect cancer, but also other breast tissue abnormalities—some of which may increase the chances of developing breast cancer in the future. While the recommended age for women to begin screening is 40, women who are at high risk may need to begin sooner.

The typical procedure for an abnormal mammogram.

Radiologists are the first people who read a patient’s mammogram. What they see determines whether a patient should continue yearly screening mammograms or if further imaging is warranted. If an area on a mammogram looks abnormal or has changed year-to-year, the radiologist will recommend further imaging and possibly biopsy. The radiologist looks closely at the breast tissue. The denser the breast tissue, the more difficult the reading because breast density and breast cancers both appear white on a mammogram. Women with denser breasts can have an increased lifetime risk for developing a breast cancer. But it’s important to know that just because someone is determined to be high-risk, it doesn’t mean they’ll necessarily develop a breast cancer or that their screening mammogram is abnormal.

What does “high-risk” actually mean?

The goal of the initial consult is to better inform patients about what being high-risk means for them and to let them know there are more options available for high-risk screenings. Patients can either be referred to St. Clair Health’s High Risk Breast Clinic by their provider or self-refer.

“Once I receive their referral,” says Brittney Gregg, a nurse practitioner at the High Risk Breast Clinic, “my office calls to set up an initial consultation where I’ll discuss why they’ve been designated as high-risk. At the initial consult I perform a breast exam, discuss their imaging, risk factors and risk assessment score, answer any questions, and customize a plan of care, including risk-reducing medications, genetic testing and/or genetic counseling, annual breast MRIs in addition to yearly mammograms, or prophylactic surgery. Once a plan is in place, I order all breast imaging. The clinic helps coordinate and organize future breast-related care. I also make sure to keep the referring provider in the loop regarding the patient’s care and future breast imaging results.”

The new High-Risk Program produces better patient outcomes.

If you’ve been identified as being at high risk for breast cancer, either through family history or annual mammogram, you may be referred to the High Risk Breast Clinic at St. Clair Health. There, a multidisciplinary team of experts in breast health will proactively manage your care and create a unique, customized plan designed to help you avoid breast cancer. “High-risk imaging is important to identify patients who would benefit from a breast MRI or genetic counseling,” says Brittney. “The goal is to be able to identify those at higher risk so we can keep a closer eye on their breast health to help prevent breast cancer from occurring or diagnosis breast cancer at the earliest stages.”

Introducing the Tyrer-Cuzick Risk Assessment Model

St. Clair Health is now using a comprehensive screening tool called the Tyrer-Cuzick Risk Assessment Model. This tool, also used by our partner Mayo Clinic, is used to gather information such as personal and obstetric history from the patient’s intake form at their screening mammogram appointment, then add breast density to the equation to calculate a score that estimates the patient’s likelihood of developing breast cancer in her lifetime. Adding the imaging data will identify more patients that may be at a higher future risk than is possible by evaluating their history alone.

By identifying potential breast cancer before it occurs, doctors can take proactive steps to develop strategies and care plans that can give patients peace of mind. The new risk calculator tool is used with every patient who comes to St. Clair for a screening mammogram.

“Over time,” says Brittney, “we’ve gotten very good at treating breast cancer. Now we want to get better at preventing it and diagnosing it at the earliest point.”