Published in UAB Insight, Fall 2006
Comprehensive patient evaluation and prevention programs
UAB’s newly launched clinic for risk assessment and prevention of breast and ovarian cancer integrates the most up-to-date evaluation tools, screening techniques, and prevention programs, arming high-risk women with knowledge to make informed decisions about strategies of care. The clinic, which also features a significant clinical research component, is one of a handful of high-risk assessment entities in the United States dedicated to breast and ovarian cancers, say clinic codirectors gynecologic oncologist Mack N. Barnes III, MD, and breast surgeon Helen Krontiras, MD.
“Risks for breast and ovarian cancers often are closely associated as family history can confer risk for both diseases,” Barnes says. “If dual assessment is indicated, we perform both evaluations, including genetic counseling and testing, in one location.” Increased access to screening and prevention programs for medically underserved patients at risk for breast and ovarian cancer also is a key component of the clinic.
UAB’s clinic joins 4 established risk assessment and prevention clinics funded by the Lynne Cohen Foundation, a nonprofit group dedicated to improving breast and ovarian cancer survival. “The collaboration allows us to offer a menu of screening and prevention research trials to patients who choose to participate,” says Krontiras, who emphasizes that the clinic’s primary mission is comprehensive clinical evaluation and counseling.
During an initial 1-hour evaluation, patients are assessed by Barnes or Krontiras and have prompt access to screening tools such as mammography, magnetic resonance imaging, pelvic ultrasound, and serum-based tests. A cancer genetics counselor provides formal genetic risk assessment and discusses pros and cons of available DNA tests. “Primary care physicians often cannot fit such time-intensive evaluations into busy daily practices,” Barnes says. “After an assessment, we work with referring physicians to carry out appropriate screening and prevention strategies,” Krontiras says.
“Patients at high risk for breast cancer generally come from 1 of 2 groups,” she explains. “Family history of breast and ovarian cancer increases risk, but inherited mutations cause only about 5% to 10% of these cancers. Other risk factors are increasing age, certain hormonal factors, nulliparity or late parity, and histologic precursors found on biopsy.” Tamoxifen is the only Food and Drug Administration-approved preventive therapy for breast cancer, but clinical trials are evaluating raloxifene, another selective estrogen receptor modulator, and other classes of drugs, such as aromatase inhibitors.
“Family history and genetic status are key factors in ovarian cancer risk assessment,” Barnes says. “Ongoing research will help scientists better target populations for ovarian cancer prevention. We also are investigating risk-reducing strategies, such as COX-2 inhibitors and oral contraceptives. Prophylactic surgery also is an option. A recent study confirmed oophorectomy in women with BRCA 1 or 2 mutations reduces ovarian cancer risk by 80% and cuts breast cancer risk by 50%.” For those at highest risk of breast cancer, bilateral prophylactic mastectomy reduces risk by at least 90%, Krontiras says. Prevention strategies for both diseases also may include lifestyle modifications and more frequent screening.