Breast cancer is the most commonly diagnosed form of cancer in women except for cancers of the skin, and the second most common cause of cancer death for American women. Each year, more than 200,000 women learn they have a diagnosis of breast cancer. Approximately 12% of women (1 in 8) will be diagnosed with cancer of the breast at some time during their lifetime.

Most breast cancer, about 90%, occurs in women without a strong family history, however for those with a family history of breast cancer they often wonder if their risk is elevated and if there is anything else they should do about it.

Breast Imaging of Oklahoma has a choice for women who think their risk is greater than the average 12%. You can become more educated about your risk and options by obtaining a breast cancer risk assessment.

Because of the increased surveillance of high-risk patients, breast cancers may be detected at stages more favorable to treatment, and patients at high risk may have decreased anxiety about breast cancer as a result of increased vigilance.

Women at increased risk of breast cancer may wish to enter our program of clinical breast exams every six months correlated with annual mammography and MRI. This program follows the recommendations of the American Cancer Society (ACS).

The process of risk assessment includes: an interview with an advanced practice nurse and/or genetic counselor that focuses on family and personal history; filling out a family history of cancer form and a breast exam.

The high risk program at Breast Imaging of Oklahoma has been in place for 7 years. Over 900 women are enrolled in the program. An interim analysis of program statistics indicated a statistically significant rate of detecting breast cancers in this group of women at an earlier stage than what would be expected if they were not being followed as stringently.

In 2007, the American Cancer Society published guidelines on following high risk women. Our program was amended to follow these guidelines.

Other risks for breast cancer:

• Gender: Simply being a woman is the main risk factor. Men can develop breast cancer as well, however, this is very rare, comprising only 1% of all breast cancers. Having a male relative with breast cancer is indicative of a possible inherited risk.
• Age: The risk for breast cancer increases with age, with 80 percent of cases occurring in women older than 50.
• Medical history: Women who have already had breast or ovarian cancer may be at increased risk for developing additional cancers. Other personal or family history of cancer may be indicative of a hereditary predisposition to breast cancer. (Link to MH’s Genetic page here)
• Biopsy history: Women with previous abnormal biopsy results such as atypical ductal hyperplasia, atypical lobular hyperplasia or lobular carcinoma in situ are about 4-5 times more likely to develop breast cancer.
• Birth control pills: Most studies show a slight or no increase in breast cancer risk in women taking birth control pills, but a decreased risk for ovarian cancer.
• Hormone Replacement Therapy: A woman's risk for breast cancer may be increased by long-term use of HRT.
• Other: Other risk factors include previous chest radiation for another cancer, having children later in life, starting your menstrual cycle early, alcohol (>2 drinks daily), obesity.

Many women who are diagnosed with breast cancer have none of the risk factors mentioned above except being a woman and aging. A new test that examines multiple small genetic differences may help predict whether a woman who is thought to have a baseline risk of breast cancer is actually at an increased risk. OncoVue™ (Intergenetics http://www.intergenetics.com/cms/index.php) provides an individualized risk prediction using a small amount of cells from inside a woman’s mouth collected by swishing with mouthwash. This test is offered at Breast Imaging of Oklahoma and is used by Dr. Craft and Melissa Hall when appropriate to determine a woman’s individualized plan of care.

The high-risk protocol program manager
MELISSA CRAFT, RN, PhD, AOCN®

Professional:
Melissa Craft, RN, PhD, AOCN® is an Oncology Clinical Nurse Specialist with Breast Imaging of Oklahoma in Edmond, Oklahoma. In this role, Dr. Craft supervises a high risk clinic and research protocol, oversees education and support for newly diagnosed breast cancer patients, and is in charge of the genetic counseling and testing program for hereditary breast and ovarian cancers.

Dr. Craft received her BSN from the University of Oklahoma in Norman, OK, her MS in nursing from the University of Oklahoma in Oklahoma City, and her PhD in Nursing from Texas Woman’s University in Denton, TX.

Dr. Craft has worked exclusively with people with breast cancer for many years and has presented many educational sessions regarding breast cancer management at the local, regional and national level. Dr. Craft has also published on breast cancer genetics, expressive writing for critical events and general aspects of the nursing care of women with breast cancer.