Issue 9 Stories

High Risk Breast Program

Helping to Empower Patients and Manage Risk

With an extensive family history of breast and ovarian cancer, Tina LaRoche knows she has to be vigilant. But for many women like Tina, an annual mammogram isn’t quite enough. That’s why Sentara Martha Jefferson created its new High-Risk Breast Program to provide comprehensive care for women who are more likely to develop breast cancer. The program offers everything from risk assessment and preventive screenings to genetic and nutritional counseling. 

LaRoche, 46, who is currently the executive director of Camp Holiday Trails in Charlottesville, first started getting screening mammograms at age 35. She knew she needed to start screenings early because her paternal grandmother died of breast and ovarian cancer before age 40, while a paternal aunt died in her 70s after battling breast cancer for many years. LaRoche’s mother and a paternal cousin also developed and recovered from breast cancer. 

Due to LaRoche’s family medical history, Virginia Breast Care physician Linda Sommers, MD, recommended that she look into the new high-risk program, which began in early 2018. Following her doctor’s recommendation, LaRoche became the program’s first official patient during its early days. 

Many patients are selected for the high-risk program using new mammography software that estimates a patient’s lifetime risk of developing breast cancer, based on questionnaires women fill out at mammogram appointments. After running that data through the software algorithm, the hospital sends notification letters to patients who have an estimated lifetime risk of greater than 20 percent. The average lifetime risk level in the United States is 12.5 percent, according to nurse practitioner Janelle Gorski, MSN, RN, ANP-BC. 

Patients who receive the letter are invited to call Gorski for a free in-depth assessment over the phone. 

“We mostly work with women who have never had breast cancer but are at a high risk and need additional screening,” Gorski notes. “However, anyone who is concerned that they may be at risk for breast cancer can call to schedule an assessment, regardless of whether they’ve had a mammogram at Sentara Martha Jefferson.” 

A New Program for Breast Health

Although Sentara Martha Jefferson has offered the individual services included in the The High-Risk Breast Program for a number of years, the new program follows a more comprehensive, preventive approach for high-risk patients. In addition, the program features a single main point of contact, helping to streamline the caregiving process for patients. 

The High-Risk Breast Program in part focuses on prevention and early detection of cancer through comprehensive screenings. In addition to receiving an annual 3D screening mammogram (also known as tomosynthesis), women in the program can choose to get an additional screening MRI or breast ultrasound once a year. Screening exams are crucial, Gorski notes, because breast cancers are much easier to treat when they’re caught early. 

The Sentara Martha Jefferson Breast Care Committee recommends that every woman—not just those at high risk—get an annual 3D screening mammogram starting at age 40, Gorski adds. Studies show that 3D mammograms help doctors detect and diagnose more cancers more easily than traditional 2D mammograms. 

“While many insurance companies cover 3D mammograms these days, patients should be sure to check their coverage levels with their insurance providers,” Gorski notes. 

As part of the program, LaRoche also met with a genetic counselor. Her sister and paternal cousin had both tested positive for BRCA1, one of the most common gene mutations (along with BRCA2) associated with a higher risk of getting breast cancer. 

“Even though my genetic testing came out negative, meaning I did not have either genetic mutation, I’m still at increased risk due to my family history of breast cancer,” LaRoche says. 

Surprisingly, although LaRoche’s mother had breast cancer, genetic testing revealed that her genetic predisposition to the disease actually comes from her father’s family. Having this information can help inform the women on that side of LaRoche’s family and encourage them to take steps to monitor their health, Gorski notes. LaRoche will continue to have annual mammograms, but now, thanks to having participated in the high-risk program, she will add an annual breast MRI to her screening schedule. Having a plan in place has helped reassure her that she and her care team are doing all they can to reduce her risk of breast cancer. 

“With all the care I’m getting, and considering how often I’m going, if breast or ovarian cancer does materialize, we’re going to be on top of it,” says LaRoche. 

Nutrition and Fitness for Cancer Prevention 

Another key component of the high-risk program involves the nutritional and fitness consultations participants receive—both of which are provided at no cost to patients, thanks to program support from the Martha Jefferson Hospital Foundation. 

A registered dietitian at Sentara Martha Jefferson talked to LaRoche about switching from a low-carb diet to one that includes a greater variety of foods and more vegetables. Her fitness consultation also helped LaRoche realize that she needed to increase her daily activity level. 

“Exercise is one of the best things people can do to prevent breast cancer and a host of other diseases, including heart disease and diabetes,” Gorski says. “We should all get a minimum of 30 minutes a day of regular physical activity, five days a week. Studies show that 150 minutes of exercise a week—including simple exercises liking taking brisk walks—makes a huge difference.” 

“It all resonated with me,” LaRoche says. “From a nutritional standpoint I now focus on eating the most beneficial, healthy foods. And I really pay attention to my daily levels of activity. By reminding myself that these steps are necessary due to my family history, I keep myself motivated to make healthy choices.” 

Informed Healthcare Decisions 

The high-risk program at Sentara Martha Jefferson gives women options and provides them with the information they need to make informed decisions about their care. 

“Most of the women I work with have breast cancer in their family, so they’ve watched someone they love have to go through this—which can make it hard to talk about their own individual risk,” Gorski says. “My greatest successes are probably helping people understand what they can do to help minimize their risk and making them feel confident in deciding to manage that risk. People often feel more comfortable when they have a plan—it gives them reassurance, and they generally feel less worried when they’re being proactive with their care.” 

LaRoche says she’s grateful that Sentara Martha Jefferson offers the High-Risk Breast Program— something that isn’t found in most community hospitals. 

“When I told my mother and my three sisters about it, they couldn’t believe how fortunate I was to have such a comprehensive program here locally,” LaRoche adds. “I feel fortunate to have such a wonderful hospital right in our neighborhood. During all of my interactions with caregivers at Sentara Martha Jefferson, I always feel like I come first—and that helps motivate me to take care of myself.” 

What are the Risk Factors for Breast Cancer? 

According to experts, no one thing makes a woman more likely to develop breast cancer. Known risk factors include: 

• Early onset of first menstruation 

• Having a first child after age 30 

• Late menopause 

• Being overweight and/or a having lack of physical activity 

• Smoking 

• Alcohol consumption (more than one drink per day for women) 

• Having dense breasts 

• Prior abnormal breast biopsy 

• Postmenopausal hormone use 

Family history also plays a role in determining who is at high risk: 

• Having a first degree relative (mother, sister or daughter) with breast cancer 

• Having the BRCA1, BRCA2 or certain other gene mutations, which can be identified through genetic testing 

Call to Schedule an Assessment 

To schedule a free initial phone consultation with the High-Risk Breast Program, call 434-654-4483. During the appointment, you’ll get a comprehensive assessment to determine if you’re at high risk for breast cancer.

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