Summary
High-risk screening programs in breast cancer are an important resource for both individuals and health care systems to ensure proper assessment and patient education.
What do cancer care providers need to know about these programs? “First and foremost, it’s important to know that high-risk programs are available,” said Melissa L. Pilewskie, MD, FACS, Director, Strategic Planning and Research, RISE Program, Memorial Sloan Kettering Cancer Center. “There are millions of women in the U.S. who could benefit from high-risk screening and education on risk reduction.”
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Original Article
The Value of High-Risk Screening Programs in Breast Cancer
Oncology Times
By Catlin Nalley
High-risk screening programs in breast cancer are an important resource for both individuals and health care systems to ensure proper assessment and patient education.
What do cancer care providers need to know about these programs? “First and foremost, it’s important to know that high-risk programs are available,” said Melissa L. Pilewskie, MD, FACS, Director, Strategic Planning and Research, RISE Program, Memorial Sloan Kettering Cancer Center. “There are millions of women in the U.S. who could benefit from high-risk screening and education on risk reduction.”
During her session at the Miami Breast Cancer Conference, “Opportunities in a High-Risk Screening Program,” Pilewskie discussed the value of these programs and how they can benefit patients as well as providers.
The Importance of Screening
High-risk screening programs, according to Pilewskie, are valuable both to patients and providers because they “promote early detection and cancer prevention through appropriate screening and offerings for risk reduction.
“Studies have reported that many women misunderstand their breast cancer risk, that a large proportion of high-risk women are under-screened, and few high-risk individuals take chemoprevention for risk reduction,” she explained. “These are all areas that are addressed in a dedicated high-risk screening program.”
When women receive proper assessment and education, they gain a better understanding of risk, which Pilewskie noted, may aid in appropriate follow through with imaging and chemoprevention recommendations.
“Furthermore,” she said, “it has been shown that specialists are more likely to counsel women on the use of chemoprevention and on the option of prophylactic surgery—areas that are vital for women to understand so that they are in a position to make educated decisions that may greatly impact their cancer risk.”
The RISE Program
Memorial Sloan Kettering offers RISE, a comprehensive program for individuals at increased risk of developing breast cancer that includes regular breast exams and imaging so that any developments can be identified and addressed immediately.
“The RISE program is a dedicated high-risk breast cancer program that aims to engage women at increased breast cancer risk by providing up-to-date surveillance, options for prevention and risk reduction, and to promote ongoing research for the high-risk community,” Pilewskie outlined.
The program monitors women with the following breast cancer risk factors: a genetic predisposition to breast cancer, a strong family history of breast cancer, a prior high-risk breast biopsy (atypia or lobular carcinoma in situ), or those with a prior history of chest wall radiation.
“Women seen in the RISE program are given a clinical risk assessment with recommendations for appropriate breast screening and are counseled on options for risk reduction,” Pilewskie said. “There are three main categories of preventative strategies that are reviewed, including the use of chemoprevention, the role of prophylactic mastectomies, and lifestyle modifications including exercise, avoidance of obesity, and alcohol consumption in moderation.
“Having a structured program has also allowed us to ask research questions regarding our high-risk population and I hope that in the future we can continue to expand on our prevention protocols.”
Key Research
Pilewskie and her team are currently working with Seema Khan, MD, at Northwestern and others on trials assessing the feasibility of topical endocrine therapy.
“Drugs such as tamoxifen are proven to significantly reduce the risk of estrogen receptor-positive breast cancer among high-risk women, although the majority of eligible women decline these therapies, often secondary to fear of side effects,” noted Pilewskie. “The current studies are asking whether these medications can be delivered directly to the breast, the organ of interest, via a gel and hopefully provide similar benefit while avoiding the side effects related to systemic distribution.”
The “phase IIB pre-surgical trial of oral tamoxifen versus transdermal 4-hydroxytamoxifen in women with DCIS of the breast” is an example of one such trial.
“In this presurgical window trial, women with estrogen receptor positive DCIS are randomized to oral tamoxifen versus the topical form of the drug. Women use the study agents for a period of time prior to surgery, then proceed with standard surgical excision,” Pilewskie explained. “Tissue is then analyzed from pre- and post-intervention to compare the two different delivery mechanisms. If we see similar drug activity and reduced side effects with the topical agent, this will open the door to exciting opportunities for prevention that could benefit millions of women.”
Session Takeaways
What are the key takeaways from this session? According to Pilewskie, it is important to realize that there is a large population of women at increased risk for breast cancer who could benefit from a high-risk program.
“Individual risk assessment is paramount to individualize screening and risk-reducing strategies for women, and there is work ongoing to try and better stratify risk among different moderate-risk populations,” she concluded. “Lastly, there is a great need for non-toxic yet effective risk-reducing strategies, an area of significant research interest of mine.”
Catlin Nalley is a contributing writer.