High Risk Patient Care
The Patient: 49-year-old female
Presented with: Concerns about her breast cancer risk
The patient presented with concerns about her personal risk of developing breast cancer. Her family history includes her mother, who was diagnosed as having bilateral breast cancer at ages 47 and 69; a maternal aunt with breast cancer diagnosed at age 29; and a cousin (the daughter of the affected aunt) who was diagnosed as having breast cancer at age 42.
Evaluated by: Multidisciplinary treatment team at UVa's High Risk Care clinic
The patient received extensive counseling about breast cancer risk assessment, genetic testing and breast cancer risk reduction and management. The treatment team recommended the patient's mother undergo genetic counseling and testing.
Diagnosis: No increased risk for breast cancer
The patient's mother was seen and evaluated in the High Risk Care clinic. She underwent genetic testing and was found to harbor a BRCA2 mutation.
The patient (the daughter of the BRCA2 mutation carrier) was then tested and found not to have inherited the gene mutation. The patient was then counseled that she was not at substantially increased risk for breast cancer.
Treatment: Only routine screenings required
Because the patient's cancer risk is not significantly elevated, UVa's treatment team recommended she should continue only with the routine breast cancer screening exams for a woman her age - annual mammography and clinical breast examinations - which can be performed by her primary care physician.
Outcome: Relief
The patient no longer lives in fear of a cancer diagnosis. "It's kind of off the radar screen for me," she says. "It's not a nagging thing anymore."
When to Refer
Patients should be referred to UVa's High Risk Care clinic if they have:
- A Gail model score of 1.8 percent or higher for a woman's five-year risk
- A personal history of abnormal test pathology, such as lobular carcinoma in situ (LCS), atypical lobular hyperplasia (ALH) or atypical ductal hyperplasia (ADH)
- Multiple family members with premenopausal breast cancer
- A history of ovarian cancer in any family member
- A family history of multiple cancers, especially among first-degree relatives such as mothers, sisters and daughters
CME Event November 10
On November 10 at 8 a.m., UVa is co-sponsoring an event for all physicians who treat women. It focuses on breast cancer risk and the management of patients at higher risk for breast cancer. For more information, call 434-243-6649.