High-Risk Breast Cancer Service

The High-Risk Breast Cancer Service at Magee-Womens Hospital employs cancer experts who provide individualized recommendations of breast cancer prevention and surveillance to those women considered at high risk for breast cancer.

Treatment plans at the High-Risk Breast Cancer Service are coordinated by a team of highly-trained surgical oncologists and medical oncologists specializing in the detection, treatment, and management of breast cancer, led by Victor G. Vogel, MD, MHS, professor of medicine and epidemiology and Donald Keenan, MD, PhD, assistant professor in the Department of Surgery.

Women and their family members concerned about breast cancer can undergo an evaluation by a team of breast cancer specialists which includes:

  • a risk assessment
  • a clinical breast exam
  • screening tests
  • genetic counseling and education about breast cancer risk and potential implications for family members
  • a personalized surveillance plan
  • prevention strategies

Who Should be Evaluated?

Women and their family members who:

  • are concerned about their risk of developing breast cancer
  • are at increased risk of breast cancer

Who is at Risk for Breast Cancer?

All women are at risk, but there are a number of risk factors which increase your chances of developing breast cancer:

  • age
    The number one risk factor for developing breast cancer is age. The older you are, the greater the risk of developing the disease. Four out of five breast cancers are diagnosed in women over fifty.
  • family history of cancer - genetic inheritance
    Having a family history of cancer means having first degree relatives (mother, sister, daughter) who had breast cancer, particularly before menopause. Two or more other close relatives such as aunts or cousins with a history of breast cancer, especially if the cancer was detected at a young age, may also increase your risk.
  • Ashkenazi Jewish descent
    Some individuals of Ashkenazi (Eastern European) Jewish heritage have been found to have an inherited characteristic that may lead to breast or ovarian cancer.
  • certain breast changes
    Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for other benign conditions may increase a woman's risk.
  • beginning your menstrual periods at an early age
  • going through menopause at a late age
  • having no children
  • having your first pregnancy after age 30

Cancer Risk Assessment

Women faced with the fear of breast cancer are concerned for their own well-being as well as that of their sisters and daughters. Women with benign breast disease or abnormal breast symptoms are uncertain if the condition places them at increased risk for developing breast cancer. A brief cancer risk assessment and counseling session is conducted to evaluate risk factors, help women understand how various factors influence their risk, and provide information on appropriate steps to reduce the risk.

Genetic Counseling and Testing

Although most breast cancers occur in women who do not have a strong family history of the disease, about 10 percent are linked to a genetic predisposition for the disease. Researchers have identified certain genes that, when changed or mutated, increase a woman's risk. Women who have a BRCA gene mutation have up to an 80 percent lifetime risk of breast cancer, and a 15 to 45 percent lifetime risk of ovarian cancer.

Depending on their personal and family history, some women may decide to have specific genes studied. Genetic testing information may help some people learn whether or not they have an increased likelihood of developing certain cancers or whether inherited factors have contributed to their own or a family member's cancer.

Read more about the Cancer Genetics Program at Magee-Womens Hospital of UPMC.

Screening Tests

The program uses tests to screen for early-stage disease in people who show no symptoms. Breast cancer screening tests conducted may include:
  • screening mammogram
    A screening mammogram is the best tool available for finding breast cancer early, before symptoms appear. Mammograms can often detect breast cancer before it can be felt. Also, a mammogram can show small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.
  • clinical breast exam
    A thorough physical examination of the breasts done by a breast cancer specialist, either a doctor or nurse practitioner.
  • GAIL model risk assessment
    Scientists at the National Cancer Institute (NCI) and the National Surgical Adjuvant Breast and Bowel Project (NSABP), have developed a breast cancer risk assessment tool that allows a health professional to project a woman's individualized estimate of risk for invasive breast cancer over a five-year period, and over her lifetime to age 90. This calculated score can then be used as a guide for breast cancer prevention and surveillance options.
  • fine needle aspiration (FNA) biopsy
    Fluid and/or tissue cells are drawn (aspirated) from a lump, through a thin needle and into a syringe. The specimen is sent to the pathology lab for analysis.

Psychosocial Support

At times, women may feel overwhelmed with issues regarding their increased risk of breast cancer or other life issues. The staff of the High-Risk Breast Cancer Service includes a social worker and a psychologist who are specially trained to help women deal with the risk of cancer. They can assist you in learning ways to cope with your concerns about developing cancer, and help you make the best decision about reducing your risk.

Research

The mission of the Women's Cancer Program, including the Breast Cancer Program and the Gynecologic Cancer Program, is to advance cancer care for women through patient care, research, and education. In support of our mission, women may be invited to participate in ongoing research studies. Our primary goal, however, is to provide appropriate care and there is no requirement to participate in research activities.

Scheduling Your Appointment

The High-Risk Breast Cancer Service is located at Hillman Cancer Center in the Shadyside area of Pittsburgh. To schedule an appointment or for more information, call 412-623-3425.