What to do when dealing
with high risk women.

Find out the best approach and treatment for high risk women.

Health Care Professionals

The Approach:

There is currently no proactive national screening program for asymptomatic women under 50 at moderate to high risk of breast cancer as a result of family history or germline mutation, including those with dense breasts.1
As a result, GPs are tasked with developing a suitable systems approach to breast cancer detection in this group of women, in collaboration with specialised services.1

As a first step, all women should be encouraged to be aware of the normal look and feel of their breasts and promptly report persistent or unusual changes to their GP.1

In terms of recommended testing, this depends on the level of risk as show in the chart below, but for moderate-to-high risk women usually includes:1,2

  • Annual 3D mammography
  • Annual MRI
  • +/– Annual ultrasound

Risk levels can be determined using the Cancer Australia calculator.

Referral to a family cancer clinic may be appropriate for those with a first degree relative <50 years diagnosed with breast cancer,1 or if there are multiple relatives diagnosed on the same side of the family.

As a guide, testing should commence 10 years before the youngest relative developed breast cancer.1

There are also lifestyle recommendations you can provide to your patients to help reduce their risk of breast cancer. These include:1,3

  • Aiming for at least 30 minutes of moderate intensity exercise every day.
  • Maintaining a healthy body weight within a body mass index (BMI) of 18.5 to 25 kg/m2.
  • If consuming alcohol, limiting this to less than 2 standard drinks per day.
  • If possible, breastfeeding any children as this has been shown to be a protective factor against breast cancer

Developing a breast cancer risk management system with an individual woman at moderate-to-high risk can be complex, depending on level of risk, availability of resources, personal preferences and the current limits of scientific knowledge.4 If the time between screening is too long then there is the risk of interval cancers, but if testing is too frequent then cost effectiveness is reduced.4 It is important to discuss the available options with each women so that the approach can be tailored to her individual levels of risk and her personal wishes.4

Reference: 1. National Breast and Ovarian Cancer Centre. Breast cancer risk factors: a review of the evidence. National Breast and Ovarian Cancer Centre, Surry Hills, NSW, 2009. 2. Skaane P et al. Radiology 2013;267:47–56. 3. Friedewald S et al. JAMA 2014;311:2499–507.  4. Rose S et al. AJRAm J Roentgenol 2013;200:1401–8. 5. Australian Institute of Health and Welfare 2013. BreastScreen Australia monitoring report 2010– 2011.Cancer series no. 77. Cat. no. CAN 74. Canberra: AIHW.

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