Women at high risk for breast cancer because of family or personal medical history can now be genetically tested and undergo other diagnostic screening through a new program at the Hospital of Saint Raphael in New Haven, Conn. Under the initiative, community surgeons active in the care of breast disease are teaming up with Saint Raphael's physicians to identify and screen women at high risk.
"The main thing with breast cancer is that there is no way to prevent it. It's all about early detection and getting women properly screened so their prognosis is good," said Deborah Brown, a Saint Raphael nurse practitioner who serves as the liaison between patients and doctors in the program. "Breast cancer is one of the cancers where there are fantastic treatments if it is caught early."
The High-Risk Breast Health Program offers initial counseling, diagnostic testing and education to women with these risk factors:
- genetics (two or more breast cancers or male breast cancer in the family)
- history of ovarian cancer
- past atypical biopsy
- dense breast tissue
Brown said the clinic is open to everyone in this urban community who has concerns about breast cancer and wants to be examined. "Anyone can come in," she said. "If someone doesn't have insurance, we have a program we can put them through and find a way to help them."
After patients are interviewed about their medical history and undergo an examination, doctors determine "the appropriate surveillance," said Brown. This might mean a mammogram, a mammogram alternating with an ultrasound every six months, a breast MRI, genetic testing or some other course of treatment. For the genetic testing, clinicians usually obtain DNA from patients' saliva or blood. Testers then can screen for certain gene mutations that can indicate a cancer risk.
"The way the program is constructed is that a team of medical professionals work closely with the patient to deliver a plan of coordinated care," said Brown, adding that the team consists of radiologists, a patient navigator, an advanced practice registered nurse, breast surgeons and oncologists.
"The patient navigator is essentially a patient advocate, there to answer questions, serve as a point of contact and offer support," said Brown. "If it's determined that the patient needs a biopsy, the patient navigator is there to support that patient during the biopsy and help educate them (on) how to care for their breast afterwards.
"Part of our mission is to make sure no patient falls through the cracks," she said. "We are really hands on with them."
Lynn Alcott, 44, of nearby Hamden, Conn., is among the patients who received such care from the breast health program. When she felt a lump in her breast, she went to a local clinic for a mammogram. Results of the mammogram suggested the lump needed to be biopsied. Clinicians recommended that Alcott go to the high-risk clinic — and she did so in November 2010.
The biopsy revealed she had cancer, but the good news is that after a lumpectomy, followed by a course of chemotherapy and radiation, she has less than a 10 percent chance of the cancer recurring. Genetic testing for hereditary breast cancer also was recommended — and done — because of her age and diagnosis. The results were negative.
"I really couldn't believe how pleasant my experience was at Saint Raphael's," said Alcott. "They made me feel very comfortable and explained everything that they were doing. Mostly, I feel very lucky that it was caught early."
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