Many women have a high risk of breast cancer due to familial and genetic factors, abnormal mammogram findings and more. The High Risk Breast Clinic provides breast cancer screening, genetic risk evaluation, and chemo-prevention for individuals at increased risk of breast cancer. Our women-led multidisciplinary team is comprised of specially trained practitioners in genetics and physicians who work together to provide education, hereditary cancer risk assessment, genetic counseling and testing, individualized cancer screening and prevention programs to people who are concerned about their personal and family history of breast cancer.

You are eligible for the clinic if you meet any of the following risk factors:

Family history/genetic factors  (family history of breast cancer or ovarian cancer or gene mutation of yourself or family members)

• Family history of a known mutation for a cancer predisposition syndrome (e.g. BRCA1 or BRCA2)
• Breast cancer diagnosed at or before 50 years of age
• Triple negative breast cancer diagnosed before 60 years of age
• Breast cancer diagnosed at any age, AND one or more of the following:

• Personal history of ovarian cancer
• Family history of ovarian cancer
• Family history of breast cancer diagnosed at or before 50 years of age
• Family history of male breast cancer
• Family history of pancreatic cancer
• Family history of metastatic prostate cancer or high grade prostate cancer (Gleason > or = 7)
• Personal or family history of follicular thyroid cancer, endometrial cancer, and/or dermatologic manifestations of Cowden syndrome
• Personal or family history of sarcoma, adrenocortical cancer, brain tumors, leukemia/lymphoma
• Ashkenazi Jewish ancestry

• Men with a personal history of breast cancer
Bilateral cancer (or two breast primaries) diagnosed at any age
• Breast cancer diagnosed at any age AND a family history of two or more relatives diagnosed with breast cancer at any age.

High risk from Risk Assessment Models 
Every woman undergoing her annual mammogram at the Breast Imaging Center at Valley View, will be screened with the Tyrer-Cuzick questionnaire (AKA IBIS tool). It is used to calculate a person’s likelihood of carrying the BRCA1 or BRCA2 mutations. It estimates the likelihood of a woman developing breast cancer in 10 years and over the course of her lifetime. The tool is used to help inform a person’s decision-making about genetic counseling and testing.

The tool estimates breast cancer risk on the basis of the following risk factors:

• Age
• Body mass index
• Age at menarche
• Obstetric history
• Age at menopause (if applicable)
• History of a benign breast condition that increases breast cancer risk (hyperplasia, atypical hyperplasia, LCIS)
• History of ovarian cancer
• Use of hormone replacement therapy
• Family history (including breast and ovarian cancer, Ashkenazi inheritance, genetic testing if done)

You and your doctor will use results from your breast cancer risk assessment to determine if you have an increased risk of breast cancer. If the model predicts a 5% or greater chance that the woman has a mutation in BRCA1, BRCA2, or both, genetic counseling is advised. We will also present an individualized plan for ongoing screening and surveillance in the high risk breast clinic.

Biopsy proven pre-malignancy
Finally, some patients will be eligible for the high risk breast clinic due to a previous breast biopsy with any of the following findings:

• Atypical ductal hyperplasia (ADH)
• Atypical lobular hyperplasia (ALH)
• Ductal carcinoma in situ (DCIS)
• Lobular carcinoma in situ (LCIS)