Issue 8 Stories
Physicians Perspective

Introducing the Sentara Martha Jefferson High-Risk Breast Program

For women at increased risk of developing breast cancer, Sentara Martha Jefferson Hospital offers a comprehensive program that includes risk assessment, breast imaging, preventive services, genetic counseling, risk-reducing medication, and a full suite of breast surgery and reconstruction options.

Who Can Benefit?

Since, unfortunately, the vast majority of breast cancers occur in women who are not known to be at high risk, most women may benefit from a formalized breast cancer risk assessment and a better understanding of breast cancer prevention. Consultations with our high-risk program navigators, along with free regular education sessions, are available to all interested patients. For women identified to be at a higher risk of developing breast cancer, we offer complete screening, prevention, education and treatment services to minimize risk and detect any areas of concern as early as possible.

High-risk screening:In addition to annual screening mammography (preferably with tomosynthesis, also known as 3D mammography), screening breast magnetic resonance imaging (MRI) scans should be considered in patients with a 20-25 percent or higher lifetime risk of developing breast cancer. Screening MRI not only looks at the tissue more closely than mammography, but also uses an intravenous dye to add a functional assessment of blood flow in the breast—as a result, MRI is a more sensitive test and is capable of detecting more breast cancers. However, screening MRI is not used on all women, since it does have a higher rate of callbacks, requiring more women to undergo additional imaging and/or biopsies after the initial scan. In select cases, whole-breast screening ultrasound also may be an appropriate test for high-risk patients. Through the hospital’s high-risk breast program, patients meet with breast cancer surgeons at Virginia Breast Care to review the risks and benefits of different screening modalities and to customize a long-term surveillance plan for each individual patient.

Prevention and education:Breast cancer risk can be modified by lifestyle changes and medication. For instance, many studies have shown that a healthy diet and regular exercise can decrease breast cancer risk. Through the hospital’s high-risk breast program, and thanks to the generous support of the Martha Jefferson Foundation, patients have no-cost access to the expertise of a registered dietitian and an exercise specialist, who can assist with planning healthy food choices, controlling weight if necessary, developing appropriate and realistic exercise goals, and answering nutrition questions. Additionally, medications are available through the high-risk program to help patients reduce their risk of developing breast cancer.

Genetic counseling:Although only about 5-10 percent of cancers are related to genetics, having a close family member with breast cancer does tend to increase a woman’s risk for getting breast cancer herself. A cancer genetic counselor can review a patient’s family history to evaluate and explain the risk of an inherited cancer, help patients understand available genetic tests, and assist in evaluating the benefits and limitations of genetic testing. Once genetic results are available, the counselor works in collaboration with other providers in the high-risk breast program to help ensure that patients understand their medical options, when needed.

Why Now?

In August 2017, Sentara Martha Jefferson Hospital initiated a program to calculate the lifetime risk of developing breast cancer for each woman undergoing screening mammography. This program utilizes the information women have traditionally provided at the time of mammography, including family history and personal factors that impact estrogen exposure, such as age of menopause. This information is put into a computer model to generate an estimate of a women’s lifetime risk of developing breast cancer. Women with a calculated risk of 20 percent or higher are considered at a high risk and should be offered increased screening and preventative services.

Sentara Martha Jefferson has been planning a high-risk breast program for some time, and with a program now in place to identify patients who could receive the greatest benefit from a comprehensive, multidisciplinary program, the time has come to provide these services in a streamlined fashion.

How Can a Patient Access These Services?

Women concerned about their breast cancer risk are encouraged to contact the high-risk breast program for a formalized risk assessment. Patients may also be referred by their primary care providers.

Many patients are identified at the time of routine screening mammography. If a woman is identified as being at high risk at the time of her mammogram at Sentara Martha Jefferson, she is notified by letter, and her physician is informed as well. The next step involves a consultation by phone or in person with a breast specialist. If a patient is determined to be at an elevated risk, her care will be coordinated by a nurse practitioner, and appointments will be made with the appropriate caregivers. The advantage of accessing care through the high-risk program is to have a single point of contact for all services, enabling the patient to take advantage of the expertise of a coordinated, comprehensive, multidisciplinary breast program.

If you are interested in learning more about the Sentara Martha Jefferson high-risk breast program, or for a no-cost assessment of your breast cancer risk, call 434-654-4483 to speak with a breast health nurse navigator.

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