Tuesday, October 22, 2013
UHS Program Identifies and Educates Those at High Risk for Breast Cancer
One of the most important reasons for choosing the UHS
Breast Center at UHS Vestal is something most patients do not even know
about. It is the assessment performed on every patient who walks through
the doors to determine if she is at high risk for breast cancer and
might be a candidate for the UHS High-Risk Breast Cancer Surveillance
At her first visit to the UHS Breast Center, every
patient is asked to complete medical history and family history forms.
What most patients do not know is that their responses are reviewed by
Camelia Lawrence, MD, FACS, a board-certified, fellowship-trained breast
surgeon and the area’s only breast surgical oncologist. Dr. Lawrence
uses data from the questionnaires to calculate the patient’s risk of
breast cancer using various computerized breast cancer risk-assessment
tools such as the Gail model, BRCAPRO and Tyrer-Cuzick model.
a patient is determined to be at high risk for breast cancer—which is
greater than 10 percent risk—we will refer him or her to genetic
counseling and testing if indicated,” says Dr. Lawrence. “We will also
enroll the patient in the UHS High-Risk Breast Cancer Surveillance
Program,” she adds.
Genetic testing looks for inherited genetic
mutations, such as breast cancer genes 1 or 2 (known as BRCA1 and
BRCA2, respectively), P53 and T10. The presence of any of these
mutations substantially increases a woman’s risk of developing breast
cancer. According to Dr. Lawrence, men can also carry and pass on these
genetic mutations, as well as develop breast cancer. In fact, “male
breast cancer accounts for about 1 to 2 percent of the breast cancers we
see annually, which equates to approximately 2,000 cases a year,” she
When she joined the UHS medical
staff in 2011, Dr. Lawrence created the UHS High-Risk Breast Cancer
Surveillance Program to assess risks and counsel patients about reducing
their risk of developing breast cancer, as well as provide
comprehensive and personalized follow-up care.
“Until we find a
cure for breast cancer, our overriding goal is to diagnose the disease
early when it’s more treatable and potentially curable,” she says.
“That’s why programs like this are so important. You have an expert who
is monitoring any changes that occur within the breast, both clinically
as well as using imaging modality.”
are four major categories of patients Dr. Lawrence and her team look
for in determining eligibility for the UHS High-Risk Breast Cancer
Surveillance Program. They are:
1. Men or women who are found to carry the BRCA1, BRCA2, P53 or T10 genetic mutations.
People with a strong family history of breast cancer, even if they do
not carry genetic mutations for the disease. These men and women will
have successive generations of family members with breast cancer,
including first-degree relatives (mother, father, sister, brother,
daughter, son) with the disease. Family members may have been diagnosed
younger than age 50 and female relatives may have had both ovarian and
3. People who have had radiation therapy to the chest
between the ages of 10 and 30 for any health reason, “are often
overlooked, but should be part of a high-risk protocol as well,”
explains Dr. Lawrence.
4. The program is also open to women who
have been diagnosed with lobular carcinoma in situ, atypical ductal
hyperplasia or atypical lobular hyperplasia. Dr. Lawrence explains that
“these are not breast cancers, but the presence of these breast diseases
greatly increases a woman’s risk for breast cancer.” She adds that
atypical ductal hyperplasia and atypical lobular hyperplasia increase a
person’s risk of breast cancer about four- or five-fold, while lobular
carcinoma in situ increases the risk for bilateral breast cancer about
The UHS High-Risk Breast
Cancer Surveillance Program is a comprehensive, personalized program for
anyone whose risk of developing breast cancer is greater than normal.
- Clinical breast exam on a six- or 12-month interval
- Annual mammograms
- Breast ultrasound and/or breast MRI as indicated
- Education about breast cancer risk
- Personalized surveillance plan
- Prevention strategies
patients also have the opportunity to discuss any implications their
genetic mutations and/or breast cancer risk has for their family
members. “There are some patients who do not want their family members
involved, and we respect their privacy,” Dr. Lawrence notes. “However,”
she continues, “the majority of patients who are found to have a genetic
mutation want to share that information with their daughters and sons
so they can understand their potential for future risk.”
Surgical and non-surgical treatment options
Lawrence and the multidisciplinary team of breast care specialists at
the center combine the latest medical and scientific knowledge to
provide patients with surgical and non-surgical options for reducing
their risk of breast cancer.
“Some women who are at high risk
for breast cancer are reluctant to come in because they think they need
to have their breast removed, but that is not true,” Dr. Lawrence says.
“Women at high risk who choose to defer surgical intervention are
enrolled in our conservative observation protocol, which combines
advanced medical and surveillance methods.”
For patients who choose a more aggressive approach, UHS offers risk-reducing prophylactic (preventive) surgery.
are some patients who say, ‘I don’t want to wait until I develop breast
cancer, I would rather undergo surgery now,’” explains Dr. Lawrence.
“The risk-reducing prophylactic surgery is a procedure that many women
who have the BRCA mutation or another genetic mutation choose.”
the patient elects the conservative or aggressive approach, Dr.
Lawrence and the UHS Breast Center team are there to help.
care is established with me, my staff and I coordinate everything going
forward,” says Dr. Lawrence. “I think a big piece of what the UHS
Breast Center offers is that once a patient sets foot through our doors
everything is taken care of from that point forward. The patient doesn’t
have to try navigating through the system; it’s a built-in protocol
where he or she is transitioned along the care continuum.”
and men who believe they are at high risk for developing breast cancer
should speak to their health care provider about referral to the UHS
Breast Center or contact the center at (607) 763-5523 for additional