September 2010

Breast Cancer - You Are At Risk, But Are You At High Risk?

Author: Virginia M. Herrmann, M.D. | Photographer: John Brackett

Breast cancer will affect one in eight women in the United States. However some women have a higher risk than one in eight.

FACTORS WHICH INCREASE A WOMAN’S RISK OF BREAST CANCER INCLUDE:
• Early age menstruation
• Late age menopause
• No children or a first child late in life (after age 35)
• Personal history of breast cancer
• Family history of breast cancer

In addition to these five factors, there are other women who are at an even higher risk for breast cancer. The National Cancer Institute estimates there are over 5 million women in the United States who are at significantly increased risk for developing breast cancer. If those women can be identified, they can be provided closer surveillance to diagnose cancer in its earliest stages, and receive guidance as to how their risk can be reduced.

WOMEN WHO ARE AT SIGNIFICANTLY INCREASED RISK HAVE
• A very strong family history of breast cancer and/or

• A biopsy that is benign (non-cancerous) on pathology examination, but has atypical cells. These women have what is called high risk pathology.

What constitutes a very strong family history? It is important to keep in mind that most women diagnosed with breast cancer will have no family history of the disease. However, a diagnosis of breast cancer in a first degree relative (e.g. mother, sister, or daughter), particularly at a young age, such as before menopause, increases a woman’s risk, with each diagnosed first degree relative. For example, a woman who has both a mother and sister with breast cancer is at greater risk than a woman with just a mother who had breast cancer.

Families who have breast cancer in multiple relatives may have hereditary breast cancer from an abnormal family gene. Breast cancer researchers have identified two abnormal genes that significantly increase a woman’s risk for breast cancer, called BRCA 1 and BRCA 2 gene.

Those who carry one of these abnormal genes are at significantly increased risk for breast cancer, as well as other cancers such as ovarian cancer. Although not common, about 5 to 10 percent of women diagnosed with breast cancer have hereditary cancer. Women who have a family history of both breast and ovarian cancer may be at particular risk for carrying an abnormal gene. If families who carry an abnormal breast cancer gene can be identified, genetic counseling and testing is available to confirm if the patient carries one of these genes, and if so, a schedule for close monitoring can be established.

What if a woman has a biopsy with high risk pathology? Any woman who has a breast biopsy should have a discussion with her physician about what was found on pathology, under the microscope. Most breast biopsies fortunately are benign, or not cancer. However, sometimes a biopsy may be benign, but have atypical or abnormal cells in either the breast milk ducts, or the breast lobules, called atypical ductal hyperplasia, or atypical lobular hyperplasia. This abnormal pathology can give a woman a four to five-fold increased risk for breast cancer. There are several other types of high risk lesions on pathology exam. A breast surgeon can discuss a woman’s pathology in detail, and give information about whether the pathology places a woman at high risk for breast cancer, and if so, close follow-up and appropriate breast imaging is extremely important.


Virginia M. Herrmann is a Surgical Oncologist specializing in Breast Care

The Breast Health Center of Hilton Head Hospital, an affiliate of the Hollings Cancer Center Comprehensive Breast Program, has a dedicated High Risk Program, where women are assessed to determine their individual risk. Patients are seen, examined, and evaluated by Dr. Virginia Herrmann, a surgical oncologist specializing in breast care, and June Kasiak-Gambla, RN, a breast care coordinator with extensive experience in risk assessment and counseling. Dr. Virginia Herrmann is a professor of surgery at MUSC, and a member of the Hollings Cancer Center Comprehensive Breast Team. The patient’s individual risk is determined and discussed in detail, along with strategy to reduce risk and detect breast cancer earlier. Once a woman has been diagnosed with high risk pathology, she can be followed more closely, have more detailed breast imaging (to include mammography, ultrasound examination, or MRI scanning) to improve early detection. Patients are also offered ways to reduce their risk of breast cancer. Some women may be candidates to receive one of two medications that have been shown to reduce breast cancer risk by 50 percent. A large trial completed in the United States, called the STAR trial, has shown that both Tamoxifen and Raloxiphene (Evista) reduce the risk of breast cancer by 50 percent. A surgeon trained and specializing in breast cancer, like Dr. Herrmann, can determine if you are a candidate for risk reduction medication. If there are clinical trials available, Yvonne Pierce, RN, the clinical trials nurse at the Breast Health Center, can educate the patient and family about the trial and whether they would be appropriate to participate in the trial.

If you think you may be at high risk for breast cancer, call the Breast Health Center at (843) 682-7377, where they can provide you with accurate estimate of your risk and the tools available to lower that risk.

MARIE VILLET AND THE BREAST HEALTH CENTER

Marie Villet’s mother was diagnosed with breast cancer at age 33. It took a radical mastectomy and chemotherapy to stop its progression. Her aunt discovered breast cancer too late and died of the disease at age 50. Marie knew she was high risk and she worried. Moving to tiny Hilton Head Island from France, Marie held little confidence that she could locate a specialist to help her in such a small community. To her relief, she discovered Dr. Virginia Herrmann and The Breast Health Center at Hilton Head Hospital.

Marie has been seeing Dr. Herrmann for nearly five years. It was through the doctor’s diligence that a small precancerous growth was detected and removed via biopsy before it turned deadly. Now, Marie gets examined every three months and has at least one MRI and one mammogram annually. This imaging helps Dr. Herrmann more clearly perceive subtle changes in the breast tissue. Despite the ongoing debate regarding annual mammography, Marie believes it’s essential to have it done every year.

Dr. Herrmann also suggests other measures to reduce Marie’s risks. As a result of Dr. Herrmann’s recommendations she has altered her diet and incorporated exercise into a daily routine. Marie enjoys candid discussions with Dr. Herrmann about what she can do personally to forestall the onset of cancer. “We have easy conversations about my various options,” said Marie with a smile. “It’s not in medical, technical terms, but in a way that’s easy to understand. She even speaks French!”

Marie Villet feels fortunate to have a specialist following her so closely. This confidence reassures her family as well. Marie’s mother did not live long enough to know her granddaughter, Amelie, but with the care she’s now receiving, Marie believes she will avoid a similar fate. “If I develop anything, it will be caught early,” she said.

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