High Risk Breast Cancer Screening

Familial breast cancer makes up 5% of all breast cancer cases. Managing patients with a family history of breast cancer can be difficult. The key is to assess each patient's risk of developing breast cancer based on their family history. This page helps patients and doctors understand how to determine specific risk levels and the best management options for breast cancer screening in high-risk women.

Key steps in evaluating a patient with a family history include:

• Assess if a patient is eligible for genetic testing

• Asses the patients overall risk based on family history, breast density

• Assign a level of risk - High risk, slightly above population risk or population risk

• Commence a screening pathway specifically for patients risk category

Asses elegibilty for genetic testing

Patients who have been diagnosed with breast cancer or those who possess a family history of breast cancer may want to consider undergoing genetic testing as a proactive measure. The Manchester Scoring System serves as a valuable tool in helping to predict the likelihood of identifying a genetic defect. Specifically, a score that exceeds 15 indicates a greater than 10% likelihood of encountering a genetic issue. Individuals who fall into this category and score above 15 should be referred to a qualified breast specialist or a genetics counseling service to engage in an informed discussion regarding the potential benefits and risks associated with genetic testing. Furthermore, patients with a calculated probability exceeding 10% are eligible for a genetic blood test that is rebateable through Medicare. The BraOVO test, which is frequently employed, examines significant genes related to breast and ovarian cancer. For patients whose scores fall below 15, the probability of discovering a genetic defect is less than 10%. Although they still have the option to pursue genetic testing, they will not be eligible for a Medicare rebate; the typical cost for the BraOVO test is around $400 and can be arranged through either a genetic counseling service or a breast specialist.

Manchester Score Sheet

Determine a patients SpecificBreast Cancer Risk

Most patients do NOT have a genetic issue that puts them at high risk. However, patients can still have a high risk of developing breast cancer even without genetic defects. Various factors can influence breast cancer risk, including:

• Age - Older age has a higher risk

• Family History (younger first degree relatives has the higher risk)

• Breast density

• Previous atypical breast biopsies

• Breast feeding - not breast feeding increases the risk

• Menopausal Hormone Therapy (MHT) - some debate but regarded as increased risk

• Pregnancy

• Obesity

Several risk factors help determine a patient's chance of developing breast cancer. High risk is defined as a 10-year risk greater than 5% or a lifetime risk greater than 25%. Various risk calculators can estimate an individual's risk and categorize them accordingly. Patients in the high-risk group should follow a specialized screening plan that uses different breast imaging methods for thorough assessment. These methods include:

• Tomosynthesis mammoraphy

• Contrast Enhanced Mammography

• Breast Ultrasound

• MRI (Only eligible if high risk)

Use the attached links to the Risk Calculators to determine a patients specific breast cancer risk. The most commonly used calculators are :

• I Prevent

• IBIS Risk Calculator(include breast density as a risk)

How to manage High Breast Cancer risk Patients?

Patients at high risk for breast cancer in the next 10 years or their lifetime should follow a high-risk surveillance plan. These patients can get Breast MRI screening (Medicare Item No 63464). Screening should start at least 5 years before the youngest family member diagnosed with breast cancer. The screening method varies by age: patients under 35 usually get both Breast MRI and Ultrasound. Mammography may be offered, but it is often less helpful than MRI for younger women with dense breasts. Contrast Enhanced mammography maybe used for patients who are claustrophobic or unable to have a MRI of the breast.

After the age of 35, a mammogram that includes contrast enhancement will be added to the list of screening techniques utilized for breast health assessment. This addition aims to improve the detection of potential abnormalities and enhance the overall effectiveness of breast cancer screening protocols.

After age 60, MRI is not recommended and is not covered by rebates because breasts usually become more fat and less dense. Mammography is very accurate for older women. If a woman still has dense breasts after 60, an MRI may be considered, but only in specific cases.

Patients who have confirmed genetic mutations, specifically those related to BRCA1 or BRCA2, will typically begin their screening process at the age of 25. This proactive approach is essential for early detection and management of potential health issues associated with these mutations.

Risk Reducing Surgery - Preventative Mastectomy

Risk Reducing Mastectomy is strongly suggested for patients who face a very high risk of developing breast cancer, particularly individuals with a lifetime risk exceeding 30%. This surgical procedure is specifically designed to significantly lower the chances of acquiring breast cancer by proactively removing breast tissue, thereby reducing the risk to approximately 4%. The most favorable outcomes have been observed in women who are under 40 years of age; however, it is important to note that anyone identified as being at high risk can thoughtfully consider this surgical option. Patients have the opportunity to choose from a variety of reconstruction options following the procedure, and there are numerous resources available to assist them in navigating these important decisions. It is crucial to understand that this is a major decision, and the surgery can indeed be postponed until after the woman has begun or completed starting a family, which also allows women at high risk the chance to breastfeed if they choose to do so. In general, mastectomy is typically recommended for patients after they reach the age of 30.

For more information on mastectomy and breast reconstruction please use the links provided.

Refer a Patient for High Risk Breast Screening

To refer a patient for high risk breast screening please contact our staff on 07-32263800 , email ben.green.reception@specialistservices.com.au or send us a message via our make a booking link