Breast cancer is the most common cancer diagnosed in women in the United States. Not everyone carries the same level of risk, and not everyone needs the same breast cancer screening plan.

We spoke with Meredith Asper, FNP-C (Family Nurse Practitioner – Certified), to learn more about who needs breast cancer screening and when they should get it.

At CU Medicine Breast Surgical Oncology – Highlands Ranch Specialty Care Center, a team of specialists works with patients across the Front Range and beyond to build personalized screening plans based on individual risk factors. Whether a patient has a family history of breast cancer, carries a genetic marker like BRCA1 or BRCA2 or simply wants to understand their options, there is a place to start.

Who is Considered High Risk for Breast Cancer?

Clinicians use validated risk assessment tools to determine whether a patient is high risk for breast cancer. These include models such as the Tyrer-Cuzick and Gail models, which estimate a patient's lifetime risk. A lifetime risk of 20% or greater generally qualifies a patient as high risk.

Several factors can contribute to elevated breast cancer risk, including:

• A known genetic mutation, such as BRCA1 or BRCA2
• A family history of breast, ovarian or prostate cancer in close relatives
• Chest radiation received during childhood, most commonly for treatment of Hodgkin lymphoma
• A prior diagnosis of certain high-risk lesions, including atypical ductal hyperplasia, atypical lobular hyperplasia or lobular carcinoma in situ, also known as LCIS

What is the Breast Surgical Oncology High-Risk Clinic and Who Is It For?

CU Medicine Breast Surgical Oncology – Highlands Ranch Specialty Care Center offers a high-risk clinic to serve patients who have been identified as high risk for breast cancer. Patients visit the clinic once a year and are directed to schedule a second clinical breast exam with their primary care provider or OB-GYN during the same year.

A typical annual plan for high-risk patients includes:

• Two clinical breast exams (one done at the high-risk clinic and one at primary care)
• One screening mammogram
• One breast MRI

“Patients are also encouraged to practice breast self-awareness. This is not the same as a formal self-exam. It simply means knowing what is normal for your body so you can notice and report any changes to your provider,” said Asper.

What Happens During Breast Cancer Screening?

High-risk screening combines two types of imaging, scheduled about six months apart, so breast tissue is evaluated at different points throughout the year.

• Mammogram: A low-dose X-ray of breast tissue. For average-risk women, mammograms are recommended starting at age 40. For high-risk patients, they may begin earlier, but not before age 30.
• Breast MRI: An MRI with and without contrast provides a more detailed look at breast tissue and is added to the screening plan for high-risk patients. MRI surveillance typically does not begin before age 25.

Once a patient is identified as high risk, insurance broadly recognizes MRI as an appropriate screening tool and typically covers it.

Proven Ways to Reduce Breast Cancer Risk

Beyond regular screening, there are steps that may meaningfully lower lifetime risk:

• Risk-reducing surgery: For patients with a known genetic mutation, a prophylactic mastectomy can reduce lifetime breast cancer risk by up to 90%.

• Medication: Depending on menopausal status, certain medications can lower risk by reducing estrogen's effect on breast tissue. A provider at the clinic can help determine whether this is a good option.
• Lifestyle: Maintaining a healthy weight, staying active, eating a balanced diet and limiting alcohol and tobacco use are all associated with lower breast cancer risk.

High-Risk Breast Cancer FAQs

What Is the Difference Between a Screening and a Diagnostic Mammogram?

A screening mammogram is a routine study for patients without symptoms. A diagnostic mammogram is ordered to evaluate a specific concern, such as a new breast mass, new breast symptom or to further evaluate an area of concern detected on screening imaging.

What Is a Contrast-Enhanced Mammogram?

This is a newer imaging option for patients at elevated risk who may not yet qualify for MRI. It uses an iodine-based contrast agent to improve the detail of a standard mammogram.

Can High-Risk Breast Cancer Patients Use Hormone Replacement Therapy (HRT)?

The evidence on hormone replacement therapy and breast cancer risk is mixed, and there is a lot of misleading information online. The clinic recommends working with a qualified women's health provider, using the lowest effective dose for the shortest necessary time. This is especially important for patients who are already at elevated risk.

Get Screened for Breast Cancer

For patients who are unsure about their breast cancer risk or have been putting off a screening, now is the time to take the first step. Early detection saves lives, and no one has to navigate this journey alone.

"Our multidisciplinary team here at CU Medicine Breast Surgical Oncology in Highlands Ranch is amazing," said Jodi Widner, MD, medical director of the practice. "Patients get a coordinated, streamlined process where, on the day of their visit, they meet with medical oncology, radiation oncology and surgical oncology."

CU Medicine Breast Surgical Oncology - Highlands Ranch Specialty Care Center is a state-of-the-art facility where patients receive comprehensive, expert breast oncology and breast reconstruction care. Advanced breast imaging and comprehensive diagnostic and biopsy services are offered at this location, ensuring top of the line care is available to everyone who enters this clinic. Learn more by calling 720-516-2122.